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BMC Pediatr. 2017 Jul 14;17(1):166. doi: 10.1186/s12887-017-0921-x.

Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants.

Author information

1
Faculty of Health Science, University of Technology Sydney, Sydney, NSW, Australia.
2
Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.
3
Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.
4
Uppsala University, Uppsala, Sweden.
5
Department of Paediatrics, University of Otago, Christchurch, New Zealand.
6
Umeå University Hospital, Umeå, Sweden.
7
Faculty of Health Science, University of Technology Sydney, Sydney, NSW, Australia. k.lui@unsw.edu.au.
8
Department of Newborn Care, Royal Hospital for Women, Barker St, Sydney, NSW, 2031, Australia. k.lui@unsw.edu.au.

Abstract

BACKGROUND:

Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes.

METHOD:

Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared.

RESULTS:

VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and ≥32 weeks, AUC 0.50-0.65; ≥1500 g and <32 weeks, AUC 0.60-0.62).

CONCLUSION:

There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking.

KEYWORDS:

Benchmarking; Infant; Intensive care; Neonatal; Outcome; Premature; Small for gestational age; Very low birth weight

PMID:
28709451
PMCID:
PMC5512978
DOI:
10.1186/s12887-017-0921-x
[Indexed for MEDLINE]
Free PMC Article

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