Journal article
Assessment of an Updated Neonatal Research Network Extremely Preterm Birth Outcome Model in the Vermont Oxford Network
JAMA pediatrics, Vol.174(5), pp.e196294-e196294
05/01/2020
DOI: 10.1001/jamapediatrics.2019.6294
PMCID: PMC7052789
PMID: 32119065
Abstract
The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) extremely preterm birth outcome model is widely used for prognostication by practitioners caring for families expecting extremely preterm birth. The model provides information on mean outcomes from 1998 to 2003 and does not account for substantial variation in outcomes among US hospitals.
To update and validate the NRN extremely preterm birth outcome model for most extremely preterm infants in the United States.
This prognostic study included 3 observational cohorts from January 1, 2006, to December 31, 2016, at 19 US centers in the NRN (derivation cohort) and 637 US centers in Vermont Oxford Network (VON) (validation cohorts). Actively treated infants born at 22 weeks' 0 days' to 25 weeks' 6 days' gestation and weighing 401 to 1000 g, including 4176 in the NRN for 2006 to 2012, 45 179 in VON for 2006 to 2012, and 25 969 in VON for 2013 to 2016, were studied. VON cohorts comprised more than 85% of eligible US births. Data analysis was performed from May 1, 2017, to March 31, 2019.
Predictive variables used in the original model, including infant sex, birth weight, plurality, gestational age at birth, and exposure to antenatal corticosteroids.
The main outcome was death before discharge. Secondary outcomes included neurodevelopmental impairment at 18 to 26 months' corrected age and measures of hospital resource use (days of hospitalization and ventilator use).
Among 4176 actively treated infants in the NRN cohort (48% female; mean [SD] gestational age, 24.2 [0.8] weeks), survival was 63% vs 62% among 3702 infants in the era of the original model (47% female; mean [SD] gestational age, 24.2 [0.8] weeks). In the concurrent (2006-2012) VON cohort, survival was 66% among 45 179 actively treated infants (47% female; mean [SD] gestational age, 24.1 [0.8] weeks) and 70% among 25 969 infants from 2013 to 2016 (48% female; mean [SD] gestational age, 24.1 [0.8] weeks). Model C statistics were 0.74 in the 2006-2012 validation cohort and 0.73 in the 2013-2016 validation cohort. With the use of decision curve analysis to compare the model with a gestational age-only approach to prognostication, the updated model showed a predictive advantage. The birth hospital contributed equally as much to prediction of survival as gestational age (20%) but less than the other factors combined (60%).
An updated model using well-known factors to predict survival for extremely preterm infants performed moderately well when applied to large US cohorts. Because survival rates change over time, the model requires periodic updating. The hospital of birth contributed substantially to outcome prediction.
Details
- Title: Subtitle
- Assessment of an Updated Neonatal Research Network Extremely Preterm Birth Outcome Model in the Vermont Oxford Network
- Creators
- Matthew A Rysavy - University of IowaJeffrey D Horbar - University of VermontEdward F Bell - University of IowaLei Li - RTI InternationalLucy T Greenberg - Vermont Oxford NetworkJon E Tyson - The University of Texas Health Science Center at HoustonRavi M Patel - Emory UniversityWaldemar A Carlo - University of Alabama at BirminghamNoelle E Younge - Duke UniversityCharles E Green - The University of Texas Health Science Center at HoustonErika M Edwards - University of VermontSusan R Hintz - Stanford UniversityMichele C Walsh - Case Western Reserve UniversityJeffrey S Buzas - University of VermontAbhik Das - RTI InternationalRosemary D Higgins - George Mason UniversityEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and Vermont Oxford Network
- Resource Type
- Journal article
- Publication Details
- JAMA pediatrics, Vol.174(5), pp.e196294-e196294
- DOI
- 10.1001/jamapediatrics.2019.6294
- PMID
- 32119065
- PMCID
- PMC7052789
- ISSN
- 2168-6203
- eISSN
- 2168-6211
- Grant note
- UG1 HD068244 / NICHD NIH HHS UG1 HD021385 / NICHD NIH HHS L40 HD099827 / NICHD NIH HHS F32 HD098782 / NICHD NIH HHS UG1 HD040492 / NICHD NIH HHS UG1 HD027851 / NICHD NIH HHS UG1 HD053089 / NICHD NIH HHS U24 HD095254 / NICHD NIH HHS UG1 HD027904 / NICHD NIH HHS UG1 HD027880 / NICHD NIH HHS UG1 HD053109 / NICHD NIH HHS UG1 HD040689 / NICHD NIH HHS UL1 TR003167 / NCATS NIH HHS UG1 HD034216 / NICHD NIH HHS UG1 HD027856 / NICHD NIH HHS UG1 HD021364 / NICHD NIH HHS K23 DK120960 / NIDDK NIH HHS UG1 HD027853 / NICHD NIH HHS UG1 HD068278 / NICHD NIH HHS UG1 HD068263 / NICHD NIH HHS
- Language
- English
- Date published
- 05/01/2020
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984354158302771
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