Modelo preditivo para displasia broncopulmonar ao final da primeira semana de vida

Abstract

Objective: To develop a predictive model capable of identifying which premature infants have the greatest probability of presenting bronchopulmonary dysplasia (BPD), based on assessment at the end of their first week of life.Methods: Data were collected retrospectively from January 1998 to July 2001, and prospectively from August 2001 to July 2003. All children born at the institution with gestational age < 34 weeks and birth weight < 1,500 g were included. The principal risk factors for BPD were subjected to univariate analysis followed by logistic regression.Significant variables were used to construct a formula to calculate the probability of BPD. The model was calibrated and its discriminative power assessed using receiver operating characteristic (ROC) curves. Between August 2003 and July 2005 the model was then applied to a different population for validation. Results:The sample comprised 247 children, of whom 68 developed BPD, classified as follows: mild = 35 (51.4%), moderate = 20 (29.4%) and severe = 8 (11.7 %). Four variables maintained significance with relation to BPD: gestational age ≤ 30 weeks, persistent ductus arteriosus, mechanical ventilation > 2 days and loss of > 15% of birth weight on the seventh day of life. Where patients exhibited all of these variables, the model had a 93.7% probability of being correct. The model was further validated when using another sample of 61 newborns; similar figures were obtained. Conclusions:At the end of the first week of life, the predictive model developed from our population was capable of identifying newborn infants at increased risk of developing BPD with a high degree of sensitivity. J Pediatr (Rio J). 2007;83(2):163-170:Bronchopulmonary dysplasia, predictive model, chronic neonatal lung disease, mechanical ventilation, prematurity. Suggested citation: Bhering CA, Mochdece CC, Moreira ME, Rocco JR, Sant' Anna GM. Bronchopulmonary dysplasia prediction model for 7-day-old infants.

Clinical prediction models for bronchopulmonary dysplasia: a systematic review and external validation study

“…Six models could not be validated because variables on either fluid intake, weight loss after the first week of life, or exact duration of high oxygen and positive inspiratory pressure were not available in the PreVILIG dataset and no proxy variable could be imputed [12,13,28,35,38,47]. …”

“…However, these variables may be difficult to assess in daily clinical practice, jeopardizing their implementation in routine care. For instance, three of the untested models included the concentration of oxygen or positive inspiratory pressure for a prescribed time [12,13,28], or included weight loss, fluid intake or urine output as predictors [35,38,47]. These variables are not collected easily even in a prospective study and more importantly are not independent of local protocols or habits [12,28].…”

Desfecho dos encaminhamentos de recém-nascidos internados na unidade de terapia intensiva neonatal do Hospital Municipal de Diadema

“…Entre as condições que afetam os recém-nascidos prematuros a DBP é umas das mais importantes, com uma incidência em torno de 24% (TAPIA et al, 2006) e apresentam riscos associados com peso e idade gestacional baixo ao nascimento, PCA e ventilação mecânica (TAPIA, 2006;BHERING et al, 2007). Esta é uma doença crônica que pode acarretar atraso no desenvolvimento pssicomotor e déficit no crescimento (LOPES et al, 1999).…”