1. THE UNIVERSITY of TENNESSEE HEALTH SCIENCE CENTER.
The Assessment of Predictive Accuracy of “NICHD extremely preterm infants outcome calculator” for Neonates with ≤500 gm Birth Weight over 20 years Kirtikumar Upadhyay, MD1,3; Ramasubbareddy Dhanireddy, MD1,2; C. A. Emeremni, PhD3; Ajay J. Talati, MD1,2,3
1Division of Neonatology, Department of Pediatrics; 2Department of Obstetrics & Gynecology; 3Children Research Foundation Center at Le Bonheur Children Hospital; University of Tennessee Health Science Center, Memphis, TN.
THE UNIVERSITY of TENNESSEE HEALTH SCIENCE CENTER
All the Authors Have No Relevant Financial Relationships to Disclose or Conflict of Interests to Resolve
RESULTS
ABSTRACT
Background: Decision making for infants at the edge of viability is complex. NICHD( has developed a calculator to predict mortality & morbidity of extremely preterm infants based on outcome data of neonatal research network centers to guide clinicians in decision making and counseling of families. Objective: To assess the accuracy of NICHD calculator in predicting survival to discharge and neurodevelopmental impairment at 24 months in infants with ≤500 gm birth weight(BW) at our center in last 20 years. Design/Methods: A retrospective database review was done for neonates with ≤500gm BW from Aug 1989 to Sept Neonates were eligible for study if information of their BW( gm), gestational age(22-26 wk), gender, antenatal steroids & number of fetuses was available. Infants with major congenital anomalies were excluded. Data were collected regarding survival to discharge & neurodevelopmental assessment of surviving infants at 24 months corrected age by measuring MDI & PDI using BSID-II. MDI & PDI <70 was considered moderate- severe and <50 was considered profound impairment. Receiver-operating characteristic(ROC) analysis was used to assess the accuracy of NICHD calculator in predicting survival and neurodevelopmental impairment at 24 months. Results: Out of NICU admissions, 219(<1%) neonates were ≤500gm BW and 148 were eligible for study. The ROC curve for accuracy of NICHD calculator in predicting survival of these infants is shown in graph below(p<0.0001). Conclusions: NICHD calculator accurately predicted the probability of survival of neonates ≤500gm BW; however, this calculator was not reliable in predicting neurodevelopmental outcome at 24 months of these infants. .
Outcomes at 24 months of
corrected age
Total =45
Death
4 (10%)
Cerebral Palsy
MDI <70 and PDI <70
15 (33%)
Hearing deficit (requiring amplification)
8 (17%)
Blindness (Bilateral)
3 (7%) .
INTRODUCTION
Advances in perinatal and neonatal care over the last 30 years have contributed to improved survival among extremely low birth weight (ELBW) infants. However, decision making for infants at the edge of viability is complex. NICHD ( has developed a calculator to predict mortality & morbidity of extremely preterm infants based on outcome data of neonatal research network centers to guide clinicians in decision making and counseling of families.
OBJECTIVE
To assess the accuracy of NICHD calculator in predicting survival to discharge and neurodevelopmental impairment at 24 months in infants with ≤500 gm birth weight(BW) admitted in our tertiary level III NICU at Memphis, TN
METHODS
A retrospective database review was done for neonates with ≤500gm BW from Aug 1989 to Sept 2009
Neonates were eligible for study if information of their BW( gm), gestational age(22-25 wk), gender, antenatal steroids & number of fetuses was available
Data were collected regarding survival to discharge & neurodevelopmental assessment of surviving infants at 24 months corrected age by measuring MDI & PDI using BSID-II
MDI & PDI <70 was considered moderate- severe and <50 was considered profound impairment
Receiver-operating characteristic(ROC) analysis was used to assess the accuracy of NICHD calculator in predicting survival and neurodevelopmental impairment at 24 months
Data are not mutually exclusive
Percentage of surviving infants at each gestational age
Number (N=148)
(%)
Survived (N=45)
(30.5%)
Died (N=103)
(69.5%)
P value
Mean BW (gm)
459.08
442.92 NS
Mean GA (wk)
23.73
23.03
Female gender (%)
36 (80%)
51 (50%)
0.0005
Antenatal Steroids (%)
29 (64.4%)
30 (29.1%)
0.0001
Singleton gestation (%)
81 (78.6%)
N=16
SUMMARY
A significant number of neonates with ≤500 gm BW survived in the past 20 years
Survival improved with increase in gestational age, use of antenatal steroids and in female infants
NICHD calculator accurately predicted the probability of survival in this cohort (AUC=0.7022)
However, the calculator was not accurate for predicting survival without profound neurodevelopmental impairment (AUC= )
CONCLUSION
NICHD calculator accurately predicted the probability of survival of neonates ≤500gm BW; however, this calculator was not reliable in predicting neurodevelopmental outcome at 24 months of these infants.
N=47
N=37
N=48
N=148
N=45
The accuracy of the NICHD calculator in predicting
probability of survival of infants with birth
weight ≤500g
The accuracy of the NICHD calculator in predicting the probability of survival without severe neurodevelopmental impairment in infants with birth-weight ≤500g