Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
PLoS One. 2011;6(9):e23441. doi: 10.1371/journal.pone.0023441. Epub 2011 Sep 8.
Being born very preterm is associated with elevated risk for neonatal mortality. The aim of this review is to give an overview of prediction models for mortality in very premature infants, assess their quality, identify important predictor variables, and provide recommendations for development of future models.
Studies were included which reported the predictive performance of a model for mortality in a very preterm or very low birth weight population, and classified as development, validation, or impact studies. For each development study, we recorded the population, variables, aim, predictive performance of the model, and the number of times each model had been validated. Reporting quality criteria and minimum methodological criteria were established and assessed for development studies.
We identified 41 development studies and 18 validation studies. In addition to gestational age and birth weight, eight variables frequently predicted survival: being of average size for gestational age, female gender, non-white ethnicity, absence of serious congenital malformations, use of antenatal steroids, higher 5-minute Apgar score, normal temperature on admission, and better respiratory status. Twelve studies met our methodological criteria, three of which have been externally validated. Low reporting scores were seen in reporting of performance measures, internal and external validation, and handling of missing data.
Multivariate models can predict mortality better than birth weight or gestational age alone in very preterm infants. There are validated prediction models for classification and case-mix adjustment. Additional research is needed in validation and impact studies of existing models, and in prediction of mortality in the clinically important subgroup of infants where age and weight alone give only an equivocal prognosis.
早产儿出生与新生儿死亡率升高有关。本综述的目的是概述极早产儿死亡率的预测模型，评估其质量，确定重要的预测变量，并为未来模型的发展提供建议。
纳入了报道极早产儿或极低出生体重儿死亡率预测模型的预测性能，并将其分类为开发、验证或影响研究的研究。对于每项开发研究，我们记录了人群、变量、目的、模型的预测性能以及模型验证的次数。为开发研究制定并评估了报告质量标准和最低方法学标准。
我们确定了 41 项开发研究和 18 项验证研究。除了胎龄和出生体重外，有八个变量经常预测生存率：符合胎龄的平均大小、女性、非白种人、没有严重先天性畸形、使用产前类固醇、较高的 5 分钟 Apgar 评分、入院时正常体温和更好的呼吸状态。有 12 项研究符合我们的方法学标准，其中有 3 项已经过外部验证。在报告性能指标、内部和外部验证以及处理缺失数据方面，报告得分较低。
多变量模型可以比出生体重或胎龄单独更好地预测极早产儿的死亡率。已经有用于分类和病例组合调整的验证预测模型。需要对现有模型的验证和影响研究以及在仅年龄和体重给出不确定预后的临床重要亚组的死亡率预测方面进行更多研究。
