Saadah Loai M, Chedid Fares D, Sohail Muhammad R, Nazzal Yazied M, Al Kaabi Mohammed R, Rahmani Aiman Y
Department of Pharmacy, Zayed Military Hospital, Abu Dhabi, United Arab Emirates.
Pharmacotherapy. 2014 Mar;34(3):251-9. doi: 10.1002/phar.1333. Epub 2013 Jul 29.
To identify subgroups of premature infants who may benefit from palivizumab prophylaxis during nosocomial outbreaks of respiratory syncytial virus (RSV) infection.
Retrospective analysis using an artificial intelligence model.
Level IIIB, 35-bed, neonatal intensive care unit (NICU) at a tertiary care hospital in the United Arab Emirates.
One hundred seventy six premature infants, born at a gestational age of 22-34 weeks, and hospitalized during four RSV outbreaks that occurred between April 2005 and July 2007.
We collected demographic and clinical data for each patient by using a standardized form. Input data consisted of seven categoric and continuous variables each. We trained, tested, and validated artificial neural networks for three outcomes of interest: mortality, days of supplemental oxygen, and length of NICU stay after the index case was identified. We compared variable impacts and performed reassignments with live predictions to evaluate the effect of palivizumab. Of the 176 infants, 31 (17.6%) received palivizumab during the outbreaks. All neural network configurations converged within 4 seconds in less than 400 training cycles. Infants who received palivizumab required supplemental oxygen for a shorter duration compared with controls (105.2 ± 7.2 days vs 113.2 ± 10.4 days, p=0.003). This benefit was statistically significant in male infants whose birth weight was less than 0.7 kg and who had hemodynamically significant congenital heart disease. Length of NICU stay after identification of the index case and mortality were independent of palivizumab use.
Palivizumab may be an effective intervention during nosocomial outbreaks of RSV in a subgroup of extremely low-birth-weight male infants with hemodynamically significant congenital heart disease.
确定在医院内呼吸道合胞病毒（RSV）感染暴发期间可能从帕利珠单抗预防中获益的早产儿亚组。
使用人工智能模型进行回顾性分析。
阿拉伯联合酋长国一家三级护理医院的ⅢB级、拥有35张床位的新生儿重症监护病房（NICU）。
176名早产儿，孕龄为22 - 34周，于2005年4月至2007年7月期间在4次RSV感染暴发期间住院。
我们使用标准化表格收集了每位患者的人口统计学和临床数据。输入数据包括7个分类变量和连续变量。我们针对三个感兴趣的结局训练、测试并验证了人工神经网络：死亡率、吸氧天数以及在确定索引病例后的NICU住院时长。我们比较了变量影响，并通过实时预测进行重新分配以评估帕利珠单抗的效果。在176名婴儿中，31名（17.6%）在暴发期间接受了帕利珠单抗治疗。所有神经网络配置在不到400个训练周期内于4秒内收敛。与对照组相比，接受帕利珠单抗治疗的婴儿吸氧时间更短（105.2±7.2天对113.2±10.4天，p = 0.003）。这种益处在出生体重小于0.7kg且患有血流动力学显著先天性心脏病的男婴中具有统计学意义。确定索引病例后的NICU住院时长和死亡率与帕利珠单抗的使用无关。
对于患有血流动力学显著先天性心脏病的极低出生体重男婴亚组，帕利珠单抗可能是医院内RSV感染暴发期间的一种有效干预措施。
