Initial Metabolic Profiles Are Associated with 7-Day Survival among Infants Born at 22-25 Weeks of Gestation

Scott P Oltman; Elizabeth E Rogers; Rebecca J Baer; James G Anderson; Martina A Steurer; Matthew S Pantell; J. Colin Partridge; Larry Rand; Kelli K Ryckman; Laura L Jelliffe-Pawlowski

doi:10.1016/j.jpeds.2018.03.032

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Initial Metabolic Profiles Are Associated with 7-Day Survival among Infants Born at 22-25 Weeks of Gestation

Journal article

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Initial Metabolic Profiles Are Associated with 7-Day Survival among Infants Born at 22-25 Weeks of Gestation

Scott P Oltman, Elizabeth E Rogers, Rebecca J Baer, James G Anderson, Martina A Steurer, Matthew S Pantell, J. Colin Partridge, Larry Rand, Kelli K Ryckman and Laura L Jelliffe-Pawlowski

The Journal of pediatrics, Vol.198, pp.194-200.e3

2018

DOI: 10.1016/j.jpeds.2018.03.032

PMCID: PMC6016556

PMID: 29661562

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Abstract

OBJECTIVE: To evaluate the association between early metabolic profiles combined with infant characteristics and survival past 7 days of age in infants born at 22-25 weeks of gestation.STUDY DESIGN: This nested case-control consisted of 465 singleton live births in California from 2005 to 2011 at 22-25 weeks of gestation. All infants had newborn metabolic screening data available. Data included linked birth certificate and mother and infant hospital discharge records. Mortality was derived from linked death certificates and death discharge information. Each death within 7 days was matched to 4 surviving controls by gestational age and birth weight z score category, leaving 93 cases and 372 controls. The association between explanatory variables and 7-day survival was modeled via stepwise logistic regression. Infant characteristics, 42 metabolites, and 12 metabolite ratios were considered for model inclusion. Model performance was assessed via area under the curve.RESULTS: The final model included 1 characteristic and 11 metabolites. The model demonstrated a strong association between metabolic patterns and infant survival (area under the curve [AUC] 0.885, 95% CI 0.851-0.920). Furthermore, a model with just the selected metabolites performed better (AUC 0.879, 95% CI 0.841-0.916) than a model with multiple clinical characteristics (AUC 0.685, 95% CI 0.627-0.742).CONCLUSIONS: Use of metabolomics significantly strengthens the association with 7-day survival in infants born extremely premature. Physicians may be able to use metabolic profiles at birth to refine mortality risks and inform postnatal counseling for infants born at <26 weeks of gestation.

Details

Title: Subtitle: Initial Metabolic Profiles Are Associated with 7-Day Survival among Infants Born at 22-25 Weeks of Gestation
Creators: Scott P Oltman
Elizabeth E Rogers
Rebecca J Baer
James G Anderson
Martina A Steurer
Matthew S Pantell
J. Colin Partridge
Larry Rand
Kelli K Ryckman
Laura L Jelliffe-Pawlowski
Resource Type: Journal article
Publication Details: The Journal of pediatrics, Vol.198, pp.194-200.e3
DOI: 10.1016/j.jpeds.2018.03.032
PMID: 29661562
PMCID: PMC6016556
NLM abbreviation: J Pediatr
ISSN: 1097-6833
eISSN: 1097-6833
Grant note: DOI: 10.13039/100000865, name: Bill & Melinda Gates Foundation, award: OPP1141549; DOI: 10.13039/100000002, name: National Institutes of Health, award: R21 HD087864
Language: English
Date published: 2018
Academic Unit: Stead Family Department of Pediatrics; Epidemiology
Record Identifier: 9983995131802771

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