Objective To determine the accuracy of the National Institute of Child Health and Human Development (NICHD) calculator in predicting death and neurodevelopmental impairment in Australian and New Zealand infants.
Design Population-based cohort study.
Setting Australia and New Zealand.
Patients Preterm infants 22–25 completed weeks gestation.
Interventions Comparison of NICHD calculator predicted rates of death and death or neurodevelopmental impairment, with actual rates recorded in the Australian and New Zealand Neonatal Network cohort.
Main outcome measures Infant death and death or neurodevelopmental impairment rates.
Results A total of 714 infants were included in the study. Of these infants, 100 (14.0%) were <24 weeks, 389 (54.5%) male, 529 (74.1%) were singletons, 42 (5.9%) had intrauterine growth restriction, 563 (78.9%) received antenatal steroids and 625 (87.5 %) were born in a tertiary hospital. There were 288 deaths (40.3%), 75 infants (10.5%) with neurodevelopment impairment and 363 (50.8%) with death or neurodevelopmental impairment. The area under the curve (AUC) for prediction of death and the composite death or neurodevelopmental impairment by the NICHD calculator in our population was 0.65(95% CI 0.61 to 0.69) and 0.65 (95% CI 0.61 to 0.69), respectively. When stratified and compared with gestational age outcomes, the AUC did not change substantially for the outcomes investigated. The calculator was less accurate with outcome predictions at the extreme categories of predicted outcomes—underestimation of outcomes for those predicted to have the lowest risk (<20%) and overestimation for those in the highest risk category (>80%).
Conclusion In our recent cohort of extremely preterm infants, the NICHD model does not accurately predict outcomes and is marginally better than gestational age based outcomes.
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Contributors KTY, AW, KL were involved in the conception and design of the work; acquisition, analysis and interpretation of the data for the manuscript; and initial drafting of the work. NS, RLM were involved in the acquisition, analysis and interpretation of the data for the work. TS, SB, RH were involved in the interpretation of the data for the manuscript. All authors were involved in the critical revision of the manuscript for intellectual content and approved the paper as submitted. All authors agree to be accountable for all aspects of the work and in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The authors KTY and TS, and the study were supported in part by a grant from the Running for Premature Babies Fund, Royal Hospital for Women Foundation. The Australian and New Zealand Neonatal Network were supported from the ANZNN members’ contribution and in part by a grant from Leslie Steven Grant for Newborn Care, Sydney Children’s Hospital Foundation, Australia, and Royal Hospital for Women Foundation, New South Wales, Australia.
Competing interests None declared.
Ethics approval South Eastern Sydney Local Health District Human Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Collaborators Advisory Council Members of ANZNN (* denotes ANZNN Executives) Australia: Peter Marshall (Flinders Medical Centre, SA), Peter Schmidt (Gold Coast Hospital, QLD), Paul Craven, Koert De Waal* (John Hunter Hospital, NSW), Karen Simmer, Andy Gill*, Jane Pillow* (King Edward Memorial and Princess Margaret Hospitals, WA), Jacqueline Stack (Liverpool Hospital, NSW), Lucy Cooke (Mater Mother’s Hospital, QLD), Dan Casalaz, Jim Holberton* (Mercy Hospital for Women, VIC), Charles Barfield (Monash Medical Centre, VIC), Lyn Downe, Vjay Singde (Nepean Hospital, NSW), Michael Stewart (Newborn Emergency Transport Service, VIC), Andrew Berry (NSW Newborn & Paediatric Emergency Transport Service), Kathryn Browning Carmo (NSW Newborn & Paediatric Emergency Transport Service), Rod Hunt (Royal Children’s Hospital, VIC), Charles Kilburn (Royal Darwin Hospital, NT), Tony de Paoli (Royal Hobart Hospital, TAS), Kei Lui* (Royal Hospital for Women, NSW), Mary Paradisis (Royal North Shore Hospital, NSW), Ingrid Rieger, Tracey Lutz, Shelley Reid* (Royal Prince Alfred Hospital, NSW), David Cartwright, Pieter Koorts (Royal Women’s Hospital, QLD), Carl Kuschel, Lex Doyle, (Royal Women’s Hospital, VIC), Andrew Numa (Sydney Children’s Hospital, NSW), Hazel Carlisle (The Canberra Hospital, ACT), Nadia Badawi (The Children’s Hospital at Westmead, NSW), Guan Koh* (The Townsville Hospital, QLD), Steven Resnick (Western Australia Neonatal Transport Service), Melissa Luig (Westmead Hospital, NSW), Chad Andersen (Women’s & Children’s Hospital, SA). New Zealand: Adrienne Lyn (Christchurch Women’s Hospital), Brian Darlow (Christchurch School of Medicine), Roland Broadbent* (Dunedin Hospital), Lindsay Mildenhall (Middlemore Hospital), Mariam Buksh (National Women’s Hospital), David Bourchier, Lee Carpenter* (Waikato Hospital), Vaughan Richardson (Wellington Women’s Hospital).ANZNN executives not members of hospitals contributing data: Ross Haslam* Chair of the executives, Georgina Chambers* (National Perinatal Statistics and Epidemiology Unit, University of New South Wales); Adam Buckmaster* (Gosford Hospital, NSW), Victor Samuel Rajadurai*, (KK Women’s and Children’s Hospital, Singapore); Barbara Bajuk* (NSW Pregnancy and Newborn Services Network)