de Boer Angret, van Beek Pauline E, Andriessen Peter, Groenendaal Floris, Hogeveen Marije, Meijer Julia S, Obermann-Borst Sylvia A, Onland Wes, Scheepers Liesbeth H C J, Vermeulen Marijn J, Verweij E J T Joanne, De Proost Lien, Geurtzen Rosa
Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Geert Grooteplein Zuid 32, 6525 GA Nijmegen, The Netherlands.
Department of Obstetrics and Gynecology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
Children (Basel). 2023 Oct 21;10(10):1712. doi: 10.3390/children10101712.
Predicting the short- and long-term outcomes of extremely preterm infants remains a challenge. Multivariable prognostic models might be valuable tools for clinicians, parents, and policymakers for providing accurate outcome estimates. In this perspective, we discuss the opportunities and challenges of using prognostic models in extremely preterm infants at population and individual levels. At a population level, these models could support the development of guidelines for decisions about treatment limits and may support policy processes such as benchmarking and resource allocation. At an individual level, these models may enhance prenatal counselling conversations by considering multiple variables and improving transparency about expected outcomes. Furthermore, they may improve consistency in projections shared with parents. For the development of prognostic models, we discuss important considerations such as predictor and outcome measure selection, clinical impact assessment, and generalizability. Lastly, future recommendations for developing and using prognostic models are suggested. Importantly, the purpose of a prognostic model should be clearly defined, and integrating these models into prenatal counselling requires thoughtful consideration.
预测极早产儿的短期和长期预后仍然是一项挑战。多变量预后模型可能是临床医生、家长和政策制定者进行准确预后评估的宝贵工具。从这个角度出发，我们讨论在极早产儿群体和个体层面使用预后模型的机遇与挑战。在群体层面，这些模型可为制定治疗限制决策指南提供支持，并可能支持诸如基准评估和资源分配等政策流程。在个体层面，这些模型可通过考虑多个变量并提高预期预后的透明度来加强产前咨询对话。此外，它们还可提高与家长分享的预测的一致性。对于预后模型的开发，我们讨论了重要的考量因素，如预测指标和结局指标的选择、临床影响评估以及可推广性。最后，提出了关于开发和使用预后模型的未来建议。重要的是，应明确界定预后模型的目的，将这些模型整合到产前咨询中需要深思熟虑。
