Sujir P Nayak, Mariela Sánchez-Rosado, Jordan D Reis, L Steven Brown, Kate L Mangona, Priya Sharma, David B Nelson, Myra H Wyckoff, Samir Pandya, Imran N Mir, Luc P Brion
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A prediction model using the new HASOFA score (Hyperglycemia, Hyperkalemia, use of inotropes for Hypotension during the prior week, Acidemia, Neonatal Sequential Organ Failure Assessment [nSOFA] score) was compared with a similar model using the nSOFA score.</p><p><strong>Results: </strong> Among 261 infants, 112 infants had NEC stage I, 68 with NEC stage II, and 81 with NEC stage III based on modified Bell's classification. The primary outcome, surgery for NEC stage III or death within a week, occurred in 81 infants (surgery in 66 infants and death in 38 infants). All infants with pneumoperitoneum or abdominal compartment syndrome either died or had surgery. The HASOFA and the nSOFA scores were evaluated in 254 and 253 infants, respectively, at the time of the initial workup for NEC. Both models were internally validated. The HASOFA model was a better predictor of surgery for NEC stage III or death within a week than the nSOFA model, with greater AUC 0.909 versus 0.825, respectively, <i>p</i> < 0.001. Combining HASOFA at initial assessment with concurrent or later presence of abdominal wall erythema or portal gas improved the prediction surgery for NEC stage III or death with AUC 0.942 or 0.956, respectively.</p><p><strong>Conclusion: </strong> Using this new internally validated prediction model, surgery for NEC stage III or death within a week can be accurately predicted at the time of initial assessment for NEC.</p><p><strong>Key points: </strong>· No available scale, at initial evaluation, accurately predicts which preterm infants will undergo surgery for NEC stage III or die within a week.. · In this retrospective cohort study of 261 preterm infants with either suspected or definite NEC we developed a new prediction model (HASOFA score).. · The HASOFA-model had high discrimination (AUC: 0.909) and excellent calibration and was internally validated..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Development of a Prediction Model for Surgery or Early Mortality at the Time of Initial Assessment for Necrotizing Enterocolitis.\",\"authors\":\"Sujir P Nayak, Mariela Sánchez-Rosado, Jordan D Reis, L Steven Brown, Kate L Mangona, Priya Sharma, David B Nelson, Myra H Wyckoff, Samir Pandya, Imran N Mir, Luc P Brion\",\"doi\":\"10.1055/a-2253-8656\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong> No available scale, at the time of initial evaluation for necrotizing enterocolitis (NEC), accurately predicts, that is, with an area under the curve (AUC) ≥0.9, which preterm infants will undergo surgery for NEC stage III or die within a week.</p><p><strong>Study design: </strong> This is a retrospective cohort study (<i>n</i> = 261) of preterm infants with <33 weeks' gestation or <1,500 g birth weight with either suspected or with definite NEC born at Parkland Hospital between 2009 and 2021. 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引用次数: 0
摘要
背景:在对坏死性小肠结肠炎(NEC)进行初步评估时,没有可用的量表能准确预测(即曲线下面积(AUC)≥ ≥ 0.9)哪些早产儿将因NEC III期而接受手术或在一周内死亡:这是一项早产儿回顾性队列研究(n=261):根据修改后的贝尔分类法,261 名早产儿中有 112 名属于 NEC I 期,68 名属于 NEC II 期,81 名属于 NEC III 期。81名婴儿(66名婴儿接受了手术,38名婴儿死亡)的主要结果是接受 NEC III 期手术或在一周内死亡。所有出现腹腔积气或腹腔隔室综合征的婴儿要么死亡,要么接受了手术。在对 254 名婴儿和 253 名婴儿进行 NEC 初步检查时,分别对 HASOFA 评分和 nSOFA 评分进行了评估。两个模型都经过了内部验证。与 nSOFA 模型相比,HASOFA 模型能更好地预测 NEC III 期手术或一周内死亡,其 AUC 分别为 0.909 和 0.825:使用这一经内部验证的新预测模型,可在对 NEC 进行初步评估时准确预测 NEC III 期手术或一周内死亡。
Development of a Prediction Model for Surgery or Early Mortality at the Time of Initial Assessment for Necrotizing Enterocolitis.
Objective: No available scale, at the time of initial evaluation for necrotizing enterocolitis (NEC), accurately predicts, that is, with an area under the curve (AUC) ≥0.9, which preterm infants will undergo surgery for NEC stage III or die within a week.
Study design: This is a retrospective cohort study (n = 261) of preterm infants with <33 weeks' gestation or <1,500 g birth weight with either suspected or with definite NEC born at Parkland Hospital between 2009 and 2021. A prediction model using the new HASOFA score (Hyperglycemia, Hyperkalemia, use of inotropes for Hypotension during the prior week, Acidemia, Neonatal Sequential Organ Failure Assessment [nSOFA] score) was compared with a similar model using the nSOFA score.
Results: Among 261 infants, 112 infants had NEC stage I, 68 with NEC stage II, and 81 with NEC stage III based on modified Bell's classification. The primary outcome, surgery for NEC stage III or death within a week, occurred in 81 infants (surgery in 66 infants and death in 38 infants). All infants with pneumoperitoneum or abdominal compartment syndrome either died or had surgery. The HASOFA and the nSOFA scores were evaluated in 254 and 253 infants, respectively, at the time of the initial workup for NEC. Both models were internally validated. The HASOFA model was a better predictor of surgery for NEC stage III or death within a week than the nSOFA model, with greater AUC 0.909 versus 0.825, respectively, p < 0.001. Combining HASOFA at initial assessment with concurrent or later presence of abdominal wall erythema or portal gas improved the prediction surgery for NEC stage III or death with AUC 0.942 or 0.956, respectively.
Conclusion: Using this new internally validated prediction model, surgery for NEC stage III or death within a week can be accurately predicted at the time of initial assessment for NEC.
Key points: · No available scale, at initial evaluation, accurately predicts which preterm infants will undergo surgery for NEC stage III or die within a week.. · In this retrospective cohort study of 261 preterm infants with either suspected or definite NEC we developed a new prediction model (HASOFA score).. · The HASOFA-model had high discrimination (AUC: 0.909) and excellent calibration and was internally validated..
期刊介绍:
The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields.
The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field.
All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication.
The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.