Newborn metabolic vulnerability profile identifies preterm infants at risk for mortality and morbidity

Scott P Oltman; Elizabeth E Rogers; Rebecca J Baer; Elizabeth A Jasper; James G Anderson; Martina A Steurer; Matthew S Pantell; Mark A Petersen; J Colin Partridge; Deborah Karasek; Kharah M Ross; Sky K Feuer; Linda S Franck; Larry Rand; John M Dagle; Kelli K Ryckman; Laura L Jelliffe-Pawlowski

doi:10.1038/s41390-020-01148-0

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Newborn metabolic vulnerability profile identifies preterm infants at risk for mortality and morbidity

Scott P Oltman, Elizabeth E Rogers, Rebecca J Baer, Elizabeth A Jasper, James G Anderson, Martina A Steurer, Matthew S Pantell, Mark A Petersen, J Colin Partridge, Deborah Karasek, …

Pediatric research, Vol.89(6), pp.1405-1413

05/2021

DOI: 10.1038/s41390-020-01148-0

PMCID: PMC8061535

PMID: 33003189

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Abstract

Identifying preterm infants at risk for mortality or major morbidity traditionally relies on gestational age, birth weight, and other clinical characteristics that offer underwhelming utility. We sought to determine whether a newborn metabolic vulnerability profile at birth can be used to evaluate risk for neonatal mortality and major morbidity in preterm infants. This was a population-based retrospective cohort study of preterm infants born between 2005 and 2011 in California. We created a newborn metabolic vulnerability profile wherein maternal/infant characteristics along with routine newborn screening metabolites were evaluated for their association with neonatal mortality or major morbidity. Nine thousand six hundred and thirty-nine (9.2%) preterm infants experienced mortality or at least one complication. Six characteristics and 19 metabolites were included in the final metabolic vulnerability model. The model demonstrated exceptional performance for the composite outcome of mortality or any major morbidity (AUC 0.923 (95% CI: 0.917-0.929). Performance was maintained across mortality and morbidity subgroups (AUCs 0.893-0.979). Metabolites measured as part of routine newborn screening can be used to create a metabolic vulnerability profile. These findings lay the foundation for targeted clinical monitoring and further investigation of biological pathways that may increase the risk of neonatal death or major complications in infants born preterm. We built a newborn metabolic vulnerability profile that could identify preterm infants at risk for major morbidity and mortality. Identifying high-risk infants by this method is novel to the field and outperforms models currently in use that rely primarily on infant characteristics. Utilizing the newborn metabolic vulnerability profile for precision clinical monitoring and targeted investigation of etiologic pathways could lead to reductions in the incidence and severity of major morbidities associated with preterm birth.

Adult

Female

Humans

Infant

Infant Mortality

Infant, Newborn

Infant, Premature

Infant, Premature, Diseases - metabolism

Infant, Premature, Diseases - mortality

Morbidity

Pregnancy

Risk Factors

Young Adult

Details

Title: Subtitle: Newborn metabolic vulnerability profile identifies preterm infants at risk for mortality and morbidity
Creators: Scott P Oltman - Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA. Scott.Oltman@ucsf.edu
Elizabeth E Rogers - Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
Rebecca J Baer - Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
Elizabeth A Jasper - Department of Epidemiology, University of Iowa, Iowa City, IA, USA
James G Anderson - Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
Martina A Steurer - Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
Matthew S Pantell - Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
Mark A Petersen - Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
J Colin Partridge - Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
Deborah Karasek - Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
Kharah M Ross - Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
Sky K Feuer - Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
Linda S Franck - School of Nursing, University of California San Francisco, San Francisco, CA, USA
Larry Rand - Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
John M Dagle - Department of Pediatrics, University of Iowa, Iowa City, IA, USA
Kelli K Ryckman - Department of Pediatrics, University of Iowa, Iowa City, IA, USA
Laura L Jelliffe-Pawlowski - Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
Resource Type: Journal article
Publication Details: Pediatric research, Vol.89(6), pp.1405-1413
DOI: 10.1038/s41390-020-01148-0
PMID: 33003189
PMCID: PMC8061535
NLM abbreviation: Pediatr Res
ISSN: 0031-3998
eISSN: 1530-0447
Grant note: K12 HD052163 / NICHD NIH HHS
Language: English
Date published: 05/2021
Academic Unit: Stead Family Department of Pediatrics; Epidemiology; Biochemistry and Molecular Biology; Neonatology
Record Identifier: 9984214830202771

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