Kanagaraj Uthaya Kumaran, Kulkarni Tapas, Kwan Eddie, Zhang Qian, Bone Jeffery, Shivananda Sandesh
Division of Neonatology, University of British Columbia and British Columbia Women's Hospital, Vancouver, BC V6H 3N1, Canada.
Department of Biostatistics, British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.
J Clin Med. 2025 Jan 22;14(3):696. doi: 10.3390/jcm14030696.
: The numerical risk of bronchopulmonary dysplasia (BPD) and/or death could be estimated using the National Institute of Child Health and Human Development (NICHD) BPD outcome estimator 2022 in extremely low gestational age (ELGA) infants during the first 4 weeks of life to facilitate prognostication, and center-specific targeted improvement interventions. However, the 2022 NICHD BPD outcome estimator's performance in the Canadian setting has not been validated. Our objective is to validate the NICHD BPD outcome estimator 2022 in predicting death and or moderate to severe BPD at 36 weeks in infants less than 29 weeks admitted to NICU. : A retrospective observational study (March 2022-August 2023) was conducted on both inborn and outborn preterm infants excluding neonates with major congenital anomalies. Infants were classified into six groups based on the predicted risk of death or Grade 2 or 3 BPD (<10%, 10-20%, 20-30%, 30-40%, 50-59%, ≥60%) followed by noting observed outcomes from the unit's database. A receiver operating characteristics (ROC) curve was used to assess the accuracy of the NICHD BPD outcome estimator 2022, with an area under curve (AUC) > 0.7 defined a priori as an acceptable predictive accuracy for local use. : Among 99 infants included, 13 (13.1%) died, and 40 (40.4%) developed BPD. Median gestational age was 26 weeks, and median birth weight was 914 g. Twenty-three infants (23.2%) received postnatal steroids. The AUC values for death or moderate to severe BPD on days 1, 3, 7, 14, and 28 were 0.803, 0.806, 0.837, 0.832, and 0.843, respectively. The AUC values for moderate to severe BPD alone on those days were 0.766, 0.746, 0.785, 0.807, and 0.818 respectively. : The 2022 BPD estimator adequately predicted the death and/or moderate to severe BPD on days 1, 3, 7, 14, and 28 of life. This tool could serve as a valid adjunct to facilitate discussion between clinicians and families on initiating time-sensitive targeted interventions to prevent or alter the course of BPD.
可使用美国国立儿童健康与人类发展研究所（NICHD）2022年支气管肺发育不良（BPD）结局评估工具，在胎龄极低（ELGA）婴儿出生后的前4周内估算BPD和/或死亡的数值风险，以利于预后判断及制定特定中心的针对性改善干预措施。然而，2022年NICHD BPD结局评估工具在加拿大环境中的性能尚未得到验证。我们的目标是验证2022年NICHD BPD结局评估工具在预测入住新生儿重症监护病房（NICU）的胎龄小于29周婴儿在36周时的死亡和/或中重度BPD情况。：对2022年3月至2023年8月期间出生的和外转的早产婴儿进行了一项回顾性观察研究，排除患有重大先天性异常的新生儿。根据预测的死亡风险或2级或3级BPD风险（<10%、10 - 20%、20 - 30%、30 - 40%、50 - 59%、≥60%）将婴儿分为六组，随后从该单位数据库中记录观察到的结局。采用受试者工作特征（ROC）曲线评估2022年NICHD BPD结局评估工具的准确性，曲线下面积（AUC）>0.7被预先定义为适用于本地的可接受预测准确性。：在纳入的99名婴儿中，13名（13.1%）死亡，40名（40.4%）发生了BPD。中位胎龄为26周，中位出生体重为914克。23名婴儿（23.2%）接受了产后类固醇治疗。第1、3、7、14和28天时，死亡或中重度BPD的AUC值分别为0.803、0.806、0.837、0.832和0.843。仅中重度BPD在这些天的AUC值分别为0.766、0.746、0.785、0.807和0.818。：2022年BPD评估工具能够充分预测出生后第1、3、7、14和28天的死亡和/或中重度BPD情况。该工具可作为一种有效的辅助手段，便于临床医生和家属就启动对时间敏感的针对性干预措施进行讨论，以预防或改变BPD的病程。
