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Online clinical tool to estimate risk of bronchopulmonary dysplasia in extremely preterm infants
  1. Rachel G Greenberg1,
  2. Scott A McDonald2,
  3. Matthew M Laughon3,
  4. David Tanaka1,
  5. Erik Jensen4,
  6. Krisa Van Meurs5,
  7. Eric Eichenwald6,7,
  8. Jane E Brumbaugh8,
  9. Andrea Duncan4,
  10. Michele Walsh9,
  11. Abhik Das10,
  12. C Michael Cotten11
  13. On behalf of Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
  1. 1 Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
  2. 2 RTI International, Research Triangle Park, North Carolina, USA
  3. 3 Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  4. 4 Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  5. 5 Division of Neonatology, Lucile Packard Children’s Hospital, Palo Alto, California, USA
  6. 6 Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  7. 7 Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  8. 8 Department of Pediatrics, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  9. 9 Department of Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
  10. 10 RTI International, Rockville, Maryland, USA
  11. 11 Pediatrics, Duke University, Durham, North Carolina, UK
  1. Correspondence to Dr Rachel G Greenberg, Department of Pediatrics, Duke University School of Medicine, Durham, USA; rachel.greenberg{at}duke.edu

Abstract

Objective Develop an online estimator that accurately predicts bronchopulmonary dysplasia (BPD) severity or death using readily-available demographic and clinical data.

Design Retrospective analysis of data entered into a prospective registry.

Setting Infants cared for at centres of the United States Neonatal Research Network between 2011 and 2017.

Patients Infants 501–1250 g birth weight and 23 0/7–28 6/7 weeks’ gestation.

Interventions None.

Main outcome measures Separate multinomial regression models for postnatal days 1, 3, 7, 14 and 28 were developed to estimate the individual probabilities of death or BPD severity (no BPD, grade 1 BPD, grade 2 BPD, grade 3 BPD) defined according to the mode of respiratory support administered at 36 weeks’ postmenstrual age.

Results Among 9181 included infants, birth weight was most predictive of death or BPD severity on postnatal day 1, while mode of respiratory support was the most predictive factor on days 3, 7, 14 and 28. The predictive accuracy of the models increased at each time period from postnatal day 1 (C-statistic: 0.674) to postnatal day 28 (C-statistic 0.741). We used these results to develop a web-based model that provides predicted estimates for BPD by postnatal day.

Conclusion The probability of BPD or death in extremely preterm infants can be estimated with reasonable accuracy using a limited amount of readily available clinical information. This tool may aid clinical prognostication, future research, and center-specific quality improvement surrounding BPD prevention.

Trial registration number NCT00063063

  • Neonatology
  • Intensive Care Units, Neonatal

Data availability statement

Data are available upon reasonable request. Data reported in this paper may be requested through a data use agreement. Further details are available at https://neonatal.rti.org/index.cfm?fuseaction=DataRequest.Home.

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Data availability statement

Data are available upon reasonable request. Data reported in this paper may be requested through a data use agreement. Further details are available at https://neonatal.rti.org/index.cfm?fuseaction=DataRequest.Home.

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Footnotes

  • Contributors RG conceptualised and designed the study, drafted the initial manuscript, interpreted the data analyses, and reviewed and revised the manuscript. RG accepts full responsibility for the work, had access to the data, and controlled the decision to publish. SAM and ADas carried out the data analysis, assisted with interpretation of the data analyses and reviewed and revised the manuscript for important intellectual content. CMC assisted with acquisition of the data, interpreted the data analyses, reviewed and revised the manuscript for important intellectual content and obtained funding to support the study. ML assisted with acquisition of data and critical revision of the manuscript for important intellectual content. DT, EJ, KVM, ECE, JEB, ADuncan, and MW provided analysis and interpretation of the data and critical revision of the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (UG1 HD21364, UG1 HD21385, UG1 HD27851, UG1 HD27853, UG1 HD27856, UG1 HD27880, UG1 HD27904, UG1 HD34216, UG1 HD36790, UG1 HD40492, UG1 HD40689, UG1 HD53089, UG1 HD53109, UG1 HD68244, UG1 HD68263, UG1 HD68270, UG1 HD68278, UG1 HD68284, UG1 HD87226, UG1 HD87229, U10 HD21373, U10 HD27856, U10 HD53119, U10 HD53124, U10 HD27871), the National Centre for Advancing Translational Sciences (UL1 TR6, UL1 TR41, UL1 TR42, UL1 TR83, UL1 TR93, UL1 TR105, UL1 TR142, UL1 TR442, UL1 TR454, UL1 TR1085, UL1 TR1108, UL1 TR1117, UL1 TR1425, UL1 TR1449) and the National Centre for Research Resources (M01 RR30, M01 RR32, M01 RR44, M01 RR54, M01 RR59, M01 RR64, M01 RR70, M01 RR80, M01 RR750, M01 RR633, M01 RR8084) provided grant support for the Neonatal Research Network.

  • Disclaimer Although the National Institute of Child Health and Human Development staff did have input into the study design, conduct, analysis, and manuscript drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.