Objectives:To construct and validate a model and derive a simple rule that is usable in any birth location for the prediction of outcome of term infants with severe asphyxia. Design:Retrospective cohort study. Setting...Objectives:To construct and validate a model and derive a simple rule that is usable in any birth location for the prediction of outcome of term infants with severe asphyxia. Design:Retrospective cohort study. Setting:Regional outborn neonatal intensive care unit. Participants:Infants with postintrapartum asphyxial hypoxic-ischemic encephalopathy (n = 375). Main Exposures:Clinical and laboratory predictors available at age 4 hours. Main Outcome Measures:A logistic regression model was developed and internally validated (with random sampling and based on the year of birth) for severe adverse outcome,which was defined as death or severe disability (severe cerebral palsy,severe developmental delay,sensorineural deafness,or cortical blindness singly or in com bination). A simple prediction rule was derived from 3 variables. Results:Complete data were available for 302 (92%) of the 345 infants with known outcomes (204 infants with severe adverse outcome). Six independent predictors of outcomes were identified. Using the 3 most significant predictors (chest compressions,age at onset of respiration,and base deficit),severe adverse outcome rates were 46%(95%confidence interval,33%-58%) with none of the 3 predictors,64%(95%confidence interval,54%-73%) with any 1 predictor,76%(95%confidence interval,66%-85%)with any 2 predictors,and 93%(95%confidence interval,81%-99%)-with all of the 3 predictors present. The internal validations revealed a robust model. Conclusions:This predictive model for neonatal hypoxic-ischemic encephalopathy provides a sliding scale of probabilities that could be used for prognostication and to design eligibility criteria for decision making including neuroprotective therapy.展开更多
Objectives: To examine whether admission hospital type (13 perinatal centers v s 4 freestanding pediatric hospitals) was associated with differences in risk an d illness severity adjusted mortality and morbidity among...Objectives: To examine whether admission hospital type (13 perinatal centers v s 4 freestanding pediatric hospitals) was associated with differences in risk an d illness severity adjusted mortality and morbidity among outborn preterm infant s. Study design: Records of singleton outborn infants ≤32 weeks’gestational ag e (n = 605) admitted to 17 tertiary level neonatal intensive care units particip ating in the Canadian Neonatal Network for the period 1996 to 1997 were examined . Results: Outborn infants admitted to freestanding pediatric hospitals were at higher risk of death (adjusted odds ratio [AOR], 2.25; 95%confidence interval [ CI], 1.20, 4.20), nosocomial infection (AOR, 2.48; 95%CI, 1.64, 3.73), and oxyg en dependency at 28 days of age (AOR, 1.77; 95%CI, 1.14, 2.75) when compared wi th outborn infants admitted to perinatal centers. Conclusions: After adjustment for perinatal risks and admission illness severity, outborn infants had better o utcomes if they were admitted to perinatal centers compared with freestanding pe diatric hospitals.展开更多
文摘Objectives:To construct and validate a model and derive a simple rule that is usable in any birth location for the prediction of outcome of term infants with severe asphyxia. Design:Retrospective cohort study. Setting:Regional outborn neonatal intensive care unit. Participants:Infants with postintrapartum asphyxial hypoxic-ischemic encephalopathy (n = 375). Main Exposures:Clinical and laboratory predictors available at age 4 hours. Main Outcome Measures:A logistic regression model was developed and internally validated (with random sampling and based on the year of birth) for severe adverse outcome,which was defined as death or severe disability (severe cerebral palsy,severe developmental delay,sensorineural deafness,or cortical blindness singly or in com bination). A simple prediction rule was derived from 3 variables. Results:Complete data were available for 302 (92%) of the 345 infants with known outcomes (204 infants with severe adverse outcome). Six independent predictors of outcomes were identified. Using the 3 most significant predictors (chest compressions,age at onset of respiration,and base deficit),severe adverse outcome rates were 46%(95%confidence interval,33%-58%) with none of the 3 predictors,64%(95%confidence interval,54%-73%) with any 1 predictor,76%(95%confidence interval,66%-85%)with any 2 predictors,and 93%(95%confidence interval,81%-99%)-with all of the 3 predictors present. The internal validations revealed a robust model. Conclusions:This predictive model for neonatal hypoxic-ischemic encephalopathy provides a sliding scale of probabilities that could be used for prognostication and to design eligibility criteria for decision making including neuroprotective therapy.
文摘Objectives: To examine whether admission hospital type (13 perinatal centers v s 4 freestanding pediatric hospitals) was associated with differences in risk an d illness severity adjusted mortality and morbidity among outborn preterm infant s. Study design: Records of singleton outborn infants ≤32 weeks’gestational ag e (n = 605) admitted to 17 tertiary level neonatal intensive care units particip ating in the Canadian Neonatal Network for the period 1996 to 1997 were examined . Results: Outborn infants admitted to freestanding pediatric hospitals were at higher risk of death (adjusted odds ratio [AOR], 2.25; 95%confidence interval [ CI], 1.20, 4.20), nosocomial infection (AOR, 2.48; 95%CI, 1.64, 3.73), and oxyg en dependency at 28 days of age (AOR, 1.77; 95%CI, 1.14, 2.75) when compared wi th outborn infants admitted to perinatal centers. Conclusions: After adjustment for perinatal risks and admission illness severity, outborn infants had better o utcomes if they were admitted to perinatal centers compared with freestanding pe diatric hospitals.
