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Updating a Perinatal Risk Scoring System to Predict Infant Mortality.

ABSTRACT: OBJECTIVE:The Birth Score Project (Project WATCH) began in the rural state of West Virginia (WV) in the United States in 1984. The project is intended to identify newborns with a greater risk of infant mortality. The primary objective of this study was to update the current Birth Score based on current literature and rigorous statistical methodology. STUDY DESIGN:The study merged data from the Birth Score, Birth Certificate (birth years 2008-2013), and Infant Mortality Data (N?=?121,640). The merged data were randomly divided into developmental (N?=?85,148) and validation (N?=?36,492) datasets. Risk scoring system was developed using the weighted multivariate risk score functions and consisted of infant and maternal factors. RESULTS:The updated score ranged from 0 to 86. Infants with a score of ?17 were categorized into the high score group (n?=?15,387; 18.1%). The odds of infant mortality were 5.6 times higher (95% confidence interval: 4.4, 7.1) among those who had a high score versus low score. CONCLUSION:The updated score is a better predictor of infant mortality than the current Birth Score. This score has practical relevance for physicians in WV to identify newborns at the greatest risk of infant mortality and refer the infants to primary pediatric services and case management for close follow-up.

SUBMITTER: Umer A

PROVIDER: S-EPMC6599540 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Updating a Perinatal Risk Scoring System to Predict Infant Mortality.

Umer Amna A Lilly Christa C Hamilton Candice C Cottrell Lesley L Lefeber Timothy T Hulsey Thomas T John Collin C

American journal of perinatology 20181228 12

<h4>Objective</h4>The Birth Score Project (Project WATCH) began in the rural state of West Virginia (WV) in the United States in 1984. The project is intended to identify newborns with a greater risk of infant mortality. The primary objective of this study was to update the current Birth Score based on current literature and rigorous statistical methodology.<h4>Study design</h4>The study merged data from the Birth Score, Birth Certificate (birth years 2008-2013), and Infant Mortality Data (<i>N< ...[more]

PMID: 30593081

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Project description:Esophageal atresia (EA) is a rare anomaly that mandates surgical intervention. Patients with EA often have complicated medical courses due to both esophageal anomalies and related comorbidities. Although several prognostic classification systems have been developed to decrease the mortality rate in EA, most systems focus only on the influence of the major anomaly, and external risk factors that could be influenced by the neonatal caregivers to a certain extent are not included. The aim of this study was to investigate the risk factors for in-hospital mortality in neonates with EA and develop a scoring model to predict mortality.In total, 198 infants with EA who were treated with surgical intervention at the Children's Hospital of Chongqing Medical University between March 2004 and June 2016 were included. The demographic information, clinical manifestations, laboratory testing, and outcomes during hospitalization were analyzed retrospectively. A predictive scoring model was developed according to the regression coefficients of the risk factors.The mortality rate was 18.1% (36/198). In the univariate analysis, higher incidences of prematurity, low birth weight, long gap, anastomotic leak, respiratory failure, postoperative sepsis, respiratory distress syndrome, pneumothorax, and septic shock were found in the nonsurvivor group than in the survivor group (P < .05). In the logistic regression analysis, anastomotic leak (OR: 10.75, 95% CI: 3.113-37.128), respiratory failure (OR: 4.104, 95% CI: 2.292-7.355), postoperative sepsis (OR: 3.564, 95% CI: 1.516-8.375), and low birth weight (OR: 8.379, 95% CI: 3.357-20.917) were associated with a high mortality rate. A scoring model for predicting death was developed with a sensitivity of 0.861, a specificity of 0.827, a positive predictive value of 0.524, and a negative predictive value of 0.963 at a cutoff of 2 points. The area under the receiver-operating characteristic curve of the score was 0.905 (95% CI, 0.863-0.948, P = .000) for death from EA. The mortality rate increased rapidly as the scores increased, and all patients with scores ≥5 died.Anastomotic leak, respiratory failure, postoperative sepsis, and low birth weight are independent risk factors for mortality in EA. Infants with a predictive score of 5 had a high risk of death.

Dataset Information

Updating a Perinatal Risk Scoring System to Predict Infant Mortality.

Publications

Updating a Perinatal Risk Scoring System to Predict Infant Mortality.

Similar Datasets

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