Prognostic model for predicting survival in very preterm infants: an external validation study

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 129; no. 4; pp. 529 - 538
• Main Authors: Beek, PE, Groenendaal, F, Onland, W, Koole, S, Dijk, PH, Dijkman, KP, Dungen, FAM, Heijst, AFJ, Kornelisse, RF, Schuerman, FABA, Westering‐Kroon, E, Witlox, RSGM, Andriessen, P, Schuit, E
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-03-2022
• Subjects: Birth weight; Calibration; Cesarean Section - statistics & numerical data; Cohort Studies; External validation; Female; Gestational age; Humans; Infant; Infant Mortality; Infant, Extremely Premature; Infant, Newborn; Infant, Very Low Birth Weight; Infants; Intensive care; Intensive Care Units, Neonatal - statistics & numerical data; Male; Medical prognosis; Models, Statistical; mortality; Neonates; Netherlands - epidemiology; Newborn babies; Population studies; prediction model; Premature babies; Registries; Survival; Validation studies; Validity; very preterm infants; Netherlands; mortality; prediction model; External validation; very preterm infants
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.17010

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 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
A high‐quality model predicting survival in very preterm infants is externally valid in an independent cohort.
Tweetable
A high‐quality model predicting survival in very preterm infants is externally valid in an independent cohort.
Linked article This article is commented on by EM McClure & RL Goldenberg pp. 539 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17014.