Usefulness of an Online Risk Estimator for Bronchopulmonary Dysplasia in Predicting Corticosteroid Treatment in Infants Born Preterm

Alain Cuna, Cynthia Liu, Shree Govindarajan, Margaret Queen, Hongying Dai, William E. Truog

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To assess the usefulness of a bronchopulmonary dysplasia (BPD) outcome estimator developed by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) in identifying high-risk preterm infants treated with steroids. Study design: This was a single-center retrospective study of infants born ≤30 weeks of gestational age. The NICHD BPD outcome estimator was used to retrospectively calculate BPD risk at various postnatal ages. The best combination of risk estimates for identifying steroid treatment was identified using stepwise model selection. A cut-off value with the best combination of sensitivity and specificity was identified using receiver operating characteristic analysis. Results: A total of 165 infants born preterm (mean gestational age 26 ± 1.6 weeks, mean birth weight 837 ± 171 g) were included. Of these, 61 were treated with steroids for BPD and 104 were not. Risk estimates for BPD or death were significantly greater in infants treated with steroids compared with controls. Both combined risk for severe BPD or death and single risk of no BPD were identified as factors with the best predictive power for identifying treatment with steroids, with accurate prediction possible as early as the second week of life. A greater than 37% risk for severe BPD or death or a less than 3% risk of no BPD on day of life 14 had 84%-92% sensitivity and 77%-80% specificity for predicting steroid treatment. Conclusion: The NICHD BPD outcome estimator can be a useful objective tool for identifying infants at high risk for BPD who may benefit from postnatal steroids.

Original languageEnglish (US)
Pages (from-to)23-28.e2
JournalJournal of Pediatrics
Volume197
DOIs
StatePublished - Jun 2018

Fingerprint

Bronchopulmonary Dysplasia
Premature Infants
Adrenal Cortex Hormones
Steroids
National Institute of Child Health and Human Development (U.S.)
Therapeutics
Gestational Age
Birth Weight
ROC Curve
Retrospective Studies

Keywords

  • bronchopulmonary dysplasia
  • postnatal corticosteroids
  • prematurity
  • risk calculator

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Usefulness of an Online Risk Estimator for Bronchopulmonary Dysplasia in Predicting Corticosteroid Treatment in Infants Born Preterm. / Cuna, Alain; Liu, Cynthia; Govindarajan, Shree; Queen, Margaret; Dai, Hongying; Truog, William E.

In: Journal of Pediatrics, Vol. 197, 06.2018, p. 23-28.e2.

Research output: Contribution to journalArticle

Cuna, Alain ; Liu, Cynthia ; Govindarajan, Shree ; Queen, Margaret ; Dai, Hongying ; Truog, William E. / Usefulness of an Online Risk Estimator for Bronchopulmonary Dysplasia in Predicting Corticosteroid Treatment in Infants Born Preterm. In: Journal of Pediatrics. 2018 ; Vol. 197. pp. 23-28.e2.
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abstract = "Objective: To assess the usefulness of a bronchopulmonary dysplasia (BPD) outcome estimator developed by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) in identifying high-risk preterm infants treated with steroids. Study design: This was a single-center retrospective study of infants born ≤30 weeks of gestational age. The NICHD BPD outcome estimator was used to retrospectively calculate BPD risk at various postnatal ages. The best combination of risk estimates for identifying steroid treatment was identified using stepwise model selection. A cut-off value with the best combination of sensitivity and specificity was identified using receiver operating characteristic analysis. Results: A total of 165 infants born preterm (mean gestational age 26 ± 1.6 weeks, mean birth weight 837 ± 171 g) were included. Of these, 61 were treated with steroids for BPD and 104 were not. Risk estimates for BPD or death were significantly greater in infants treated with steroids compared with controls. Both combined risk for severe BPD or death and single risk of no BPD were identified as factors with the best predictive power for identifying treatment with steroids, with accurate prediction possible as early as the second week of life. A greater than 37{\%} risk for severe BPD or death or a less than 3{\%} risk of no BPD on day of life 14 had 84{\%}-92{\%} sensitivity and 77{\%}-80{\%} specificity for predicting steroid treatment. Conclusion: The NICHD BPD outcome estimator can be a useful objective tool for identifying infants at high risk for BPD who may benefit from postnatal steroids.",
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