Prognostic model for predicting survival in very preterm infants: an external validation study
EPI-DAF study group
(2022) BJOG: An International Journal of Obstetrics and Gynaecology, volume 129, issue 4, pp. 529 - 538
(Article)
Abstract
Objective: To perform a temporal and geographical validation of a prognostic model, considered of highest methodological quality in a recently published systematic review, for predicting survival in very preterm infants admitted to the neonatal intensive care unit. The original model was developed in the UK and included gestational age, birthweight
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and gender. Design: External validation study in a population-based cohort. Setting: Dutch neonatal wards. Population or sample: All admitted white, singleton infants born between 23+0 and 32+6 weeks of gestation between 1 January 2015 and 31 December 2019. Additionally, the model’s performance was assessed in four populations of admitted infants born between 24+0 and 31+6 weeks of gestation: white singletons, non-white singletons, all singletons and all multiples. Methods: The original model was applied in all five validation sets. Model performance was assessed in terms of calibration and discrimination and, if indicated, it was updated. Main outcome measures: Calibration (calibration-in-the-large and calibration slope) and discrimination (c statistic). Results: Out of 6092 infants, 5659 (92.9%) survived. The model showed good external validity as indicated by good discrimination (c statistic 0.82, 95% CI 0.79–0.84) and calibration (calibration-in-the-large 0.003, calibration slope 0.92, 95% CI 0.84–1.00). The model also showed good external validity in the other singleton populations, but required a small intercept update in the multiples population. Conclusions: A high-quality prognostic model predicting survival in very preterm infants had good external validity in an independent, nationwide cohort. The accurate performance of the model indicates that after impact assessment, implementation of the model in clinical practice in the neonatal intensive care unit could be considered. Tweetable abstract: A high-quality model predicting survival in very preterm infants is externally valid in an independent cohort.
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Keywords: External validation, mortality, prediction model, very preterm infants, Obstetrics and Gynaecology
ISSN: 1470-0328
Publisher: Wiley-Blackwell
Note: Funding Information: Drs. van Beek was supported by an unrestricted grant from Stichting Tiny & Anny van Doorne Fonds. The funding source had no role in the design, conduct, analyses, or reporting of the study or in the decision to submit the manuscript for publication. The other authors received no external funding. Dr van Beek was supported by an unrestricted grant from Stichting Tiny & Anny van Doorne Fonds. The funding source had no role in the design, conduct, analyses or reporting of the study or in the decision to submit the manuscript for publication. The other authors received no external funding. We thank Dr S.E. Seaton and Prof. B.N. Manktelow for providing the baseline characteristics of the original development study. Written permission was obtained from both to include their names in this Acknowledgements section. SES and BNM did not receive any compensation for their contributions. The EPI-DAF study group (project leader, Peter Andriessen) and EPI-DAF PhD student (Pauline van Beek) are indebted to all collaborators, including paediatricians, psychologists and physiotherapists of all perinatal centres in the Netherlands: Amsterdam UMC location AMC (PI: Aleid van Wassenaer-Leemhuis), Amsterdam UMC location VUmc (PI: Céleste Laarman), Erasmus MC (PI: Renate Swarte), Isala Clinics (PI: Susanne Mulder-de Tollenaer), LUMC (PI: Monique Rijken), Maastricht UMC+ (PI: Elke van Westering-Kroon), Máxima MC (PI: Ellen de Kort), Radboud UMC (PI: Katerina Steiner), UMCG (PI: Henk ter Horst) and UMC Utrecht (PI: Corine Koopman-Esseboom). The EPI-DAF study group is also grateful for the support by the Netherlands Perinatal Registry (Perined; Lisa Broeders, Ger de Winter), the Dutch working group on Neonatal Follow-up (LNF; Cornelieke Aarnoudse-Moens, Monique Rijken, Renate Swarte), the Dutch National Neonatal Registry Working Group (LNR; Floris Groenendaal, René Kornelisse) and the Neonatology Network Netherlands (N3; Debbie Nuytemans, Wes Onland). Funding Information: The EPI‐DAF study group (project leader, Peter Andriessen) and EPI‐DAF PhD student (Pauline van Beek) are indebted to all collaborators, including paediatricians, psychologists and physiotherapists of all perinatal centres in the Netherlands: Amsterdam UMC location AMC (PI: Aleid van Wassenaer‐Leemhuis), Amsterdam UMC location VUmc (PI: Céleste Laarman), Erasmus MC (PI: Renate Swarte), Isala Clinics (PI: Susanne Mulder‐de Tollenaer), LUMC (PI: Monique Rijken), Maastricht UMC+ (PI: Elke van Westering‐Kroon), Máxima MC (PI: Ellen de Kort), Radboud UMC (PI: Katerina Steiner), UMCG (PI: Henk ter Horst) and UMC Utrecht (PI: Corine Koopman‐Esseboom). The EPI‐DAF study group is also grateful for the support by the Netherlands Perinatal Registry (Perined; Lisa Broeders, Ger de Winter), the Dutch working group on Neonatal Follow‐up (LNF; Cornelieke Aarnoudse‐Moens, Monique Rijken, Renate Swarte), the Dutch National Neonatal Registry Working Group (LNR; Floris Groenendaal, René Kornelisse) and the Neonatology Network Netherlands (N3; Debbie Nuytemans, Wes Onland). Funding Information: Dr van Beek was supported by an unrestricted grant from Stichting Tiny & Anny van Doorne Fonds. The funding source had no role in the design, conduct, analyses or reporting of the study or in the decision to submit the manuscript for publication. The other authors received no external funding. Publisher Copyright: © 2021 John Wiley & Sons Ltd.
(Peer reviewed)