Multivariable Predictive Models of Death or Neurodevelopmental Impairment Among Extremely Low Birth Weight Infants Using Heart Rate Characteristics - 22/02/22
, Waldemar A. Carlo, MD 2, T. Michael O'Shea, MD 3, Robert L. Schelonka, MD 4for the
HRC neurodevelopmental follow-up investigators∗
Abstract |
Objective |
We hypothesized that a cumulative heart rate characteristics (HRC) index in real-time throughout the neonatal intensive care unit (NICU) hospitalization, alone or combined with birth demographics and clinical characteristics, can predict a composite outcome of death or neurodevelopmental impairment (NDI).
Study design |
We performed a retrospective analysis using data from extremely low birth weight infants who were monitored for HRC during neonatal intensive care. Surviving infants were assessed for NDI at 18-22 months of age. Multivariable predictive modeling of subsequent death or NDI using logistic regression, cross-validation with repeats, and step-wise feature elimination was performed each postnatal day through day 60.
Results |
Among the 598 study participants, infants with the composite outcome of death or moderate-to-severe NDI had higher mean HRC scores during their stay in the NICU (3.1 ± 1.8 vs 1.3 ± 0.8; P < .001). Predictive models for subsequent death or NDI were consistently higher when the cumulative mean HRC score was included as a predictor variable. A parsimonious model including birth weight, sex, ventilatory status, and cumulative mean HRC score had a cross-validated receiver-operator characteristic curve as high as 0.84 on days 4, 5, 6, and 8 and as low as 0.78 on days 50-52 and 56-58 to predict subsequent death or NDI.
Conclusions |
In extremely low birth weight infants, higher mean HRC scores throughout their stay in the NICU were associated with a higher risk of the composite outcome of death or NDI.
Trial registration |
ClinicalTrials.gov: NCT00307333
Le texte complet de cet article est disponible en PDF.Keywords : newborn infant, infant, infant health, infant, extremely low birth weight, infant, low birth weight, infant, extremely premature, NICU, multivariable predictive model, logistic regression, cross validation, heart rate characteristics, HRC, heart rate variability, HRV, randomized controlled trial, RCT, late onset sepsis, LOS, neurodevelopmental impairment, NDI, extremely low birth weight, ELBW
Abbreviations : cmHRC, ELBW, HRC, NDI, NICU, NICHD, ROC
Plan
| Portions of this study were presented at the Pediatric Academic Societies annual meeting, April 30th-June 4th, 2021 (virtual). |
|
| W.K. is employed by and has equity shares in Medical Predictive Science Corporation, Charlottesville, Virginia. W.C. is a board director at Mednax. No funding was provided for the current research. The original randomized controlled trial was supported by the National Institutes of Heath (R01-HD48562 [to W.C., M.O., and R.S.]) and by Medical Predictive Science Corporation (to W.K.). |
Vol 242
P. 137 - mars 2022 Retour au numéro
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