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08-01-2012 | Legal medicine | Article

Western countries ‘should adopt’ UK’s prognostic models for stillbirth, neonatal death

Abstract

Free abstract

MedWire News: Two prognostic models for stillbirth and neonatal death developed for the UK could be used in other Western countries, including the Netherlands, researchers say.

The models for very preterm infants show "remarkably good external validity" and "excellent ability to discriminate" between infants who die and infants who survive, report Ewoud Schuit (Erasmus MC University Medical Centre, Rotterdam, the Netherlands) and co-authors in the journal Pediatrics.

Their analysis included 17,852 infants who were known to be alive at the onset of labor and 11,578 infants admitted for neonatal intensive care. All infants were born between January 2000 and December 2007, had a gestational age of 22-32 weeks, and were of European ethnicity.

The two prognostic models predicted survival for infants known to be alive at labor onset and for those who were admitted to a neonatal intensive care unit. Risk factors included in the former model were readily available variables including gestational age, birthweight, gender, ethnicity, and multiplicity of pregnancy, while the latter model also included fetal gender as an additional variable.

Of the infants known to be alive at the onset of labor, 2939 (16.7%) died during labor or within 28 days of birth. Of the infants admitted to neonatal intensive care, 908 (7.8%) died before being discharged.

The authors note that there was no significant difference in gender, plurality, or mother's age between the two groups of infants. However, infants in the intensive care unit who died were often older and heavier than those who died in the other group.

The prognostic model for predicting stillbirth and neonatal death among babies known to be alive at the onset of labor had a good calibration and "excellent" discriminative ability, state the authors, at a c-statistic of 0.92.

Similarly, the prognostic model for babies admitted to neonatal intensive care was also "well calibrated" and had a "good" discriminative ability, albeit lower than that of the other model, at a c-statistic of 0.82.

"The overall observed deaths were similar to the mean predicted risks for both models, indicating that the models estimate the risk of death for Dutch infants accurately," the authors write.

Commenting on the implications of their study, Schuit et al write: "Information on the risk of perinatal death of very preterm infants can be of great value for translating the effect of new interventions, developing treatment protocols, counseling parents, and adjusting individual treatment."

They acknowledge that although the variables used in both models are already familiar to caregivers as influencing the outcomes of a newborn, the advantage of using the prognostic models is that the "characteristics are combined in a more formal way, allowing for more accurate mortality risk estimation."

Schuit and colleagues conclude: "The models and the accompanying graphs can be used for clinical practice in the Netherlands and probably in other Western countries as well."

By Piriya Mahendra

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