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Prediction of survival without morbidity for infants born at under 33 weeks gestational age: a user-friendly graphical tool
  1. Prakesh S Shah1,2,
  2. Xiang Y Ye1,
  3. Anne Synnes3,
  4. Nicole Rouvinez-Bouali4,
  5. Wendy Yee5,
  6. Shoo K Lee1,2,
  7. the Canadian Neonatal Network
  1. 1Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada
  2. 2Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, Canada
  3. 3Department of Paediatrics, University of British Columbia, Vancouver, Canada
  4. 4Department of Paediatrics, University of Ottawa, Ottawa, Canada
  5. 5Department of Paediatrics, Calgary University, Calgary, Canada
  1. Correspondence to Prakesh S Shah, Department of Pediatrics, Mount Sinai Hospital, 775A - 600 University Avenue, Toronto, Canada M5G1X5; pshah{at}


Objective To develop models and a graphical tool for predicting survival to discharge without major morbidity for infants with a gestational age (GA) at birth of 22–32 weeks using infant information at birth.

Design Retrospective cohort study.

Setting Canadian Neonatal Network data for 2003–2008 were utilised.

Patients Neonates born between 22 and 32 weeks gestation admitted to neonatal intensive care units in Canada.

Main outcome measure Survival to discharge without major morbidity defined as survival without severe neurological injury (intraventricular haemorrhage grade 3 or 4 or periventricular leukomalacia), severe retinopathy (stage 3 or higher), necrotising enterocolitis (stage 2 or 3) or chronic lung disease.

Results Of the 17 148 neonates who met the eligibility criteria, 65% survived without major morbidity. Sex and GA at birth were significant predictors. Birth weight (BW) had a significant but non-linear effect on survival without major morbidity. Although maternal information characteristics such as steroid use, improved the prediction of survival without major morbidity, sex, GA at birth and BW for GA predicted survival without major morbidity almost as accurately (area under the curve: 0.84). The graphical tool based on the models showed how the GA and BW for GA interact, to enable prediction of outcomes especially for small and large for GA infants.

Conclusion This graphical tool provides an improved and easily interpretable method to predict survival without major morbidity for very preterm infants at the time of birth. These curves are especially useful for small and large for GA infants.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Members of the Canadian Neonatal Network Shoo K Lee (Director, Canadian Neonatal Network), Prakesh S Shah (Associate Director, Canadian Neonatal Network and Mount Sinai Hospital, Toronto, ON), Wayne Andrews (Janeway Children's Health and Rehabilitation Centre, St John's, NL), Francine Lefebvre (St Justine's Hospital, Montreal, QC), Wendy Yee (Foothill's Hospital, Calgary, AB), Barbara Bullied (Everett Chalmers Hospital, Fredericton, NB), Rody Canning (Moncton Hospital, Moncton, NB), Gerarda Cronin (St Boniface General Hospital, Winnipeg, MB), Kimberly Dow (Kingston General Hospital, Kingston, ON), Michael Dunn (Sunnybrook Health Sciences Centre, Toronto, ON), Suzanne Ferland (St François d’Assise Hôpital, Québec City, QC), Adele Harrison (Victoria General Hospital, Victoria, BC), Andrew James (Hospital for Sick Children, Toronto, ON), Zarin Kalapesi (Regina General Hospital, Regina, SK), Lajos Kovacs (Jewish General Hospital, Montreal, QC), Jean Lachapelle (Hôpital Maisonneuve-Rosemont, Montréal, QC), David S C Lee (St Joseph's Health Centre, London, ON), Douglas D McMillan (IWK Health Centre, Halifax, NS), Cecil Ojah (St John Regional Hospital, St John, NB), Abraham Peliowski (Royal Alexandra Hospital, Edmonton, AB), Bruno Piedboeuf (Centre Hospitalier Universitaire de Quebec, Sainte Foy, QC), Patricia Riley (Montreal Children's Hospital, Montreal, QC), Daniel Faucher (Royal Victoria Hospital, Montreal, QC), Nicole Rouvinez-Bouali (Children's Hospital of Eastern Ontario, Ottawa, ON), Koravangattu Sankaran (Royal University Hospital, Saskatoon, SK), Mary Seshia (Health Sciences Centre, Winnipeg, MB), Sandesh Shivananda (Hamilton Health Sciences Centre, Hamilton, ON), Todd Sorokan (Royal Columbian Hospital, New Westminster, BC), Anne Synnes (Children's and Women's Health Centre of British Columbia, Vancouver, BC) and Herve Walti (Centre Hospitalier Universitaire de Sherbrooke, Fleurimont, QC).