Multivariable Predictive Models of Death or Neurodevelopmental Impairment Among Extremely Low Birth Weight Infants Using Heart Rate Characteristics

HRC neurodevelopmental follow-up investigators

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: We hypothesized that a cumulative heart rate characteristics (HRC) index in real-time throughout the neonatal intensive care unit (NICU) hospitalization, alone or combined with birth demographics and clinical characteristics, can predict a composite outcome of death or neurodevelopmental impairment (NDI). Study design: We performed a retrospective analysis using data from extremely low birth weight infants who were monitored for HRC during neonatal intensive care. Surviving infants were assessed for NDI at 18-22 months of age. Multivariable predictive modeling of subsequent death or NDI using logistic regression, cross-validation with repeats, and step-wise feature elimination was performed each postnatal day through day 60. Results: Among the 598 study participants, infants with the composite outcome of death or moderate-to-severe NDI had higher mean HRC scores during their stay in the NICU (3.1 ± 1.8 vs 1.3 ± 0.8; P <.001). Predictive models for subsequent death or NDI were consistently higher when the cumulative mean HRC score was included as a predictor variable. A parsimonious model including birth weight, sex, ventilatory status, and cumulative mean HRC score had a cross-validated receiver-operator characteristic curve as high as 0.84 on days 4, 5, 6, and 8 and as low as 0.78 on days 50-52 and 56-58 to predict subsequent death or NDI. Conclusions: In extremely low birth weight infants, higher mean HRC scores throughout their stay in the NICU were associated with a higher risk of the composite outcome of death or NDI. Trial registration: ClinicalTrials.gov:

Original languageEnglish (US)
Pages (from-to)137-144.e4
JournalJournal of Pediatrics
Volume242
DOIs
StatePublished - Mar 2022

Keywords

  • ELBW
  • HRC
  • HRV
  • LOS
  • NDI
  • NICU
  • RCT
  • cross validation
  • extremely low birth weight
  • heart rate characteristics
  • heart rate variability
  • infant
  • infant health
  • infant, extremely low birth weight
  • infant, extremely premature
  • infant, low birth weight
  • late onset sepsis
  • logistic regression
  • multivariable predictive model
  • neurodevelopmental impairment
  • newborn infant
  • randomized controlled trial

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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