A Clinical Prediction Rule for Histological Chorioamnionitis in Preterm Newborns

Autor: Peter Andriessen, Boris W. Kramer, René F. Kornelisse, Sizzle F. Vanterpool, Jasmijn D. E. de Rooij, Christel J. A. W. van Gool, Martien C. J. M. van Dongen, G. Ingrid J. G. Rours, Ronald R. de Krijger, Jasper V Been, Luc J. I. Zimmermann
Přispěvatelé: RS: CAPHRI School for Public Health and Primary Care, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, Kindergeneeskunde, Epidemiologie, Family Medicine, RS: GROW - School for Oncology and Reproduction, Pediatrics, Pathology
Rok vydání: 2012
Předmět:
Epidemiology
HOSPITAL COHORT
lcsh:Medicine
RESPIRATORY-DISTRESS-SYNDROME
Clinical prediction rule
Chorioamnionitis
Umbilical cord
Pediatrics
Cohort Studies
Pregnancy
Clinical Epidemiology
CORD BLOOD
Pediatric Epidemiology
lcsh:Science
Multidisciplinary
UMBILICAL-CORD
Obstetrics
Gestational age
Obstetrics and Gynecology
medicine.anatomical_structure
Observational Studies
Medicine
Female
Infant
Premature
Cohort study
Research Article
Test Evaluation
medicine.medical_specialty
Clinical Research Design
Preeclampsia
Diagnostic Medicine
medicine
Humans
ANTENATAL STEROIDS
Inflammation
business.industry
Preterm Labor
lcsh:R
Infant
Newborn
Immunity
Modeling
BRONCHOPULMONARY DYSPLASIA
medicine.disease
MECHANICAL VENTILATION
PREMATURE RUPTURE
Bronchopulmonary dysplasia
ROC Curve
CHRONIC LUNG-DISEASE
FETAL INFLAMMATION
Clinical Immunology
lcsh:Q
Neonatology
business
Zdroj: PLOS ONE, 7(10):e46217. Public Library of Science
PLoS ONE, Vol 7, Iss 10, p e46217 (2012)
PLoS ONE
PLoS One (print), 7(10). Public Library of Science
ISSN: 1932-6203
Popis: BACKGROUND: Histological chorioamnionitis (HC) is an intrauterine inflammatory process highly associated with preterm birth and adverse neonatal outcome. HC is often clinically silent and diagnosed postnatally by placental histology. Earlier identification could facilitate treatment individualisation to improve outcome in preterm newborns. AIM: Develop a clinical prediction rule at birth for HC and HC with fetal involvement (HCF) in preterm newborns. METHODS: Clinical data and placental pathology were obtained from singleton preterm newborns (gestational age ≤ 32.0 weeks) born at Erasmus UMC Rotterdam from 2001 to 2003 (derivation cohort; n = 216) or Máxima MC Veldhoven from 2009 to 2010 (validation cohort; n = 206). HC and HCF prediction rules were developed with preference for high sensitivity using clinical variables available at birth. RESULTS: HC and HCF were present in 39% and 24% in the derivation cohort and in 44% and 22% in the validation cohort, respectively. HC was predicted with 87% accuracy, yielding an area under ROC curve of 0.95 (95%CI = 0.92-0.98), a positive predictive value of 80% (95%CI = 74-84%), and a negative predictive value of 93% (95%CI = 88-96%). Corresponding figures for HCF were: accuracy 83%, area under ROC curve 0.92 (95%CI = 0.88-0.96), positive predictive value 59% (95%CI = 52-62%), and negative predictive value 97% (95%CI = 93-99%). External validation expectedly resulted in some loss of test performance, preferentially affecting positive predictive rather than negative predictive values. CONCLUSION: Using a clinical prediction rule composed of clinical variables available at birth, HC and HCF could be predicted with good test characteristics in preterm newborns. Further studies should evaluate the clinical value of these rules to guide early treatment individualisation.
Databáze: OpenAIRE
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