Five‐year outcomes for extremely preterm babies with active perinatal management: A clinical prediction model
Caroline Diguisto, Andrei Scott Morgan, Laurence Foix L’Hélias, Veronique Pierrat, Pierre‐Yves Ancel, Jérémie F. Cohen, Francois Goffinet- Obstetrics and Gynecology
Abstract
Objective
To develop and validate a clinical prediction model for outcomes at 5 years of age for children born extremely preterm and receiving active perinatal management.
Design
The EPIPAGE‐2 national prospective cohort.
Setting
France, 2011.
Population
Live‐born neonates between 24+0 and 26+6 weeks of gestation who received active perinatal management (i.e. birth in a tertiary‐level hospital, with antenatal steroids and resuscitation at birth).
Methods
A prediction model using logistic modelling, including gestational age, small‐for gestational‐age (SGA) status and sex, was developed. Model performance was assessed through calibration and discrimination, with bootstrap internal validation.
Main outcome measures
Survival without moderate or severe neurodevelopmental disability (NDD) at 5 years.
Results
Among the 557 neonates included, 401 (72%) survived to 5 years, of which 59% survived without NDD (95% CI 54% to 63%). Predicted rates of survival without NDD ranged from 45% (95% CI 33% to 57%), to 56% (95% CI 49% to 64%) to 64% (95% CI 57% to 70%) for neonates born at 24, 25 and 26 weeks of gestation, respectively. Predicted rates of survival without NDD were 47% (95% CI 18% to 76%) and 62% (95% CI 49% to 76%) for SGA and non‐SGA children, respectively. The model showed good calibration (calibration slope 0.85, 95% CI 0.54 to 1.16; calibration‐in‐the‐large −0.0123, 95% CI −0.25 to 0.23) and modest discrimination (C‐index 0.59, 95% CI 0.53 to 0.65).
Conclusions
A simple prediction model using three factors easily known antenatally may help doctors and families in their decision‐making for extremely preterm neonates receiving active perinatal management.