1
|
Zhuang L, Li ZK, Zhu YF, Ju R, Hua SD, Yu CZ, Li X, Zhang YP, Li L, Yu Y, Zeng W, Cui J, Chen XY, Peng JY, Li T, Feng ZC. Predicting risk of severe neonatal outcomes in preterm infants born from mother with prelabor rupture of membranes. BMC Pregnancy Childbirth 2022; 22:538. [PMID: 35787798 PMCID: PMC9252037 DOI: 10.1186/s12884-022-04855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal complications are common burdens for neonates born from mother with pPROM. Physicians and parents sometimes need to make critical decisions about neonatal care with short- and long-term implications on infant's health and families and it is important to predict severe neonatal outcomes with high accuracy. METHODS The study was based on our prospective study on 1001 preterm infants born from mother with pPROM from August 1, 2017, to March 31, 2018 in three hospitals in China. Multivariable logistic regression analysis was applied to build a predicting model incorporating obstetric and neonatal characteristics available within the first day of NICU admission. We used enhanced bootstrap resampling for internal validation. RESULTS One thousand one-hundred pregnancies with PROM at preterm with a single fetus were included in our study. SNO was diagnosed in 180 (17.98%) neonates. On multivariate analysis of the primary cohort, independent factors for SNO were respiratory support on the first day,, surfactant on day 1, and birth weight, which were selected into the nomogram. The model displayed good discrimination with a C-index of 0.838 (95%CI, 0.802-0.874) and good calibration performance. High C-index value of 0.835 could still be reached in the internal validation and the calibration curve showed good agreement. Decision curve analysis showed if the threshold is > 15%, using our model would achieve higher net benefit than model with birthweight as the only one predictor. CONCLUSION Variables available on the first day in NICU including respiratory support on the first day, the use of surfactant on the first day and birthweight could be used to predict the risk of SNO in infants born from mother with pPROM with good discrimination and calibration performance.
Collapse
Affiliation(s)
- Lu Zhuang
- Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China.,National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China.,Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Zhan-Kui Li
- Northwest Women's and Children's Hospital, Xi'an, Shanxi province, China
| | - Yuan-Fang Zhu
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong province, China
| | - Rong Ju
- School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Shao-Dong Hua
- Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Chun-Zhi Yu
- Northwest Women's and Children's Hospital, Xi'an, Shanxi province, China
| | - Xing Li
- Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Yan-Ping Zhang
- Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Lei Li
- Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Yan Yu
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong province, China
| | - Wen Zeng
- School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Cui
- Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Xin-Yu Chen
- Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Jing-Ya Peng
- Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Ting Li
- Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Zhi-Chun Feng
- Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China. .,National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China. .,Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China.
| |
Collapse
|
2
|
Detection of small for gestational age in preterm prelabor rupture of membranes by Hadlock versus the Fetal Medicine Foundation growth charts. Obstet Gynecol Sci 2021; 64:248-256. [PMID: 33486918 PMCID: PMC8138067 DOI: 10.5468/ogs.20267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/25/2020] [Indexed: 11/08/2022] Open
Abstract
Objective The primary outcome was to compare the diagnostic accuracy of neonatal small for gestational age (SGA) by the Hadlock and Fetal Medicine Foundation (FMF) charts in our cohort, followed by the ability to predict composite severe neonatal outcomes (SNO) in pregnancies with preterm prelabor rupture of membranes (PPROM). Methods This study was a secondary analysis of a prospective cohort of pregnancies with PPROM from 2015 to 2018, from 23 to 36 completed weeks of gestation. Sensitivity, specificity, and positive and negative predictive values for the primary and secondary outcomes of the Hadlock and FMF fetal charts were calculated. The discriminatory ability of each chart was compared using the area under the receiver’s operating curves of clinical characteristics. Results Of the 106 women who met the inclusion criteria, 48 (45%) were screened positive using the FMF fetal growth chart and 22 (21%) were screened positive using the Hadlock chart. SGA was diagnosed in 12 infants (11%). Both fetal growth charts had comparable diagnostic accuracies and were statistically significant predictors of SGA (Hadlock: area under the receiver operating characteristic curves [AUC], 0.76, risk ratio [RR], 7.6, 95% confidence interval [CI], 2.5–23; and FMF: AUC, 0.76 RR, 13.3 95%CI 1.8–99.3). Both growth standards were poor predictors of SNO. Conclusion The Hadlock and FMF fetal growth charts have a similar accuracy to predict SGA in pregnancies complicated by PPROM. The FMF fetal growth chart may result in a 2-fold increase in positive screens, potentially increasing fetal surveillance.
Collapse
|
3
|
Duncan JR, Sawangkum P, Hoover EA, Aziz MM, Vilchez G. Birthweight and Apgar at 5 minutes of life for the prediction of severe neonatal outcomes in preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med 2020; 35:4521-4525. [PMID: 33403889 DOI: 10.1080/14767058.2020.1854214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of our study was to investigate the predictive accuracy of clinical variables available after delivery for severe neonatal outcomes (SNO) in pregnancies complicated by PPROM. MATERIALS AND METHODS This was a secondary analysis of a prospective cohort of pregnancies complicated by PPROM. We included expectant mothers from 13-46 years of age who were between 23 and 36 6/7 weeks of gestation. We excluded multiple gestations, complex fetal anomalies, those with fetal demise and outborn infants. Our primary outcome was a composite of SNO (respiratory distress syndrome, necrotizing enterocolitis, Intra-ventricular hemorrhage, sepsis, and death). The variables assessed where gestational age at delivery, birthweight, Apgar score at 5 min of life, Apgar <7 at 5 min of life, small for gestational age, sex, umbilical artery pH, and mode of delivery. Logistic regression was performed to evaluate the predictive accuracy of each of these variables. Stepwise multivariable logistic regression was utilized to assess the effect of variables with univariate analysis p value <.10 and those baseline characteristics with a statistically significant association with our composite score. RESULTS We included 108 infants. SNO was diagnosed in 44 (41%) neonates. The Apgar score at 5 min (AUC = 0.89; p= <.001), the birthweight (AUC = 0.88; p= <.001), gestational age at delivery (AUC = 0.87; p= <.001), and the Apgar score < 7 at 5 min (AUC = 0.73; p= <0.001) were statistical significant predictors of SNO. Sex (p=.15), mode of delivery (p=.15), umbilical artery Ph (p=.28), SGA (p=.85) were not statistically significant predictors of SNO. After stepwise multivariable logistic regression only the Apgar at 5 min and birth weight remained statistically significant predictors for SNO (AUC = 0.94). CONCLUSIONS In pregnancies complicated by PPROM the birthweight and the Apgar at 5 min of life are accurate predictors of a composite score of SNO. We acknowledge the need for larger and more diverse studies to corroborate our findings. BRIEF RATIONALE We assessed the predictive accuracy of clinical variables available after delivery for severe neonatal outcomes in pregnancies complicated by PPROM. We found that the birthweight and the Apgar score at 5 min were accurate predictors of such outcomes in this population. Our results may aid providers in the counseling of premature infants born after PPROM.
Collapse
Affiliation(s)
- Jose R Duncan
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA.,Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Peeraya Sawangkum
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Elizabeth A Hoover
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Michael M Aziz
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gustavo Vilchez
- Department of Obstetrics and Gynecology, University of Missouri at Kansas, Kansas City, MO, USA
| |
Collapse
|