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Am J Perinatol 2018; 35(13): 1331-1338
DOI: 10.1055/s-0038-1654712
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Early Pulse Oximetry Data Improves Prediction of Death and Adverse Outcomes in a Two-Center Cohort of Very Low Birth Weight Infants

B. A. Sullivan
1   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
A. Wallman-Stokes
2   Department of Pediatrics, Columbia University, New York, New York
,
J. Isler
2   Department of Pediatrics, Columbia University, New York, New York
,
R. Sahni
2   Department of Pediatrics, Columbia University, New York, New York
,
J. R. Moorman
3   Department of Medicine, University of Virginia, Charlottesville, Virginia
,
K. D. Fairchild
1   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
D. E. Lake
3   Department of Medicine, University of Virginia, Charlottesville, Virginia
› Author Affiliations Funding This research was supported by research grants from the NICHD (NIH R01 HD072071), the UVA Translational Health Research Institute of Virginia (THRIV), and the Little Giraffe Foundation.
Further Information

Publication History

21 December 2017

18 April 2018

Publication Date:
28 May 2018 (online)

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Abstract

Background We previously showed, in a single-center study, that early heart rate (HR) characteristics predicted later adverse outcomes in very low birth weight (VLBW) infants. We sought to improve predictive models by adding oxygenation data and testing in a second neonatal intensive care unit (NICU).

Methods HR and oxygen saturation (SpO2) from the first 12 hours and first 7 days after birth were analyzed for 778 VLBW infants at two NICUs. Using multivariate logistic regression, clinical predictive scores were developed for death, severe intraventricular hemorrhage (sIVH), bronchopulmonary dysplasia (BPD), treated retinopathy of prematurity (tROP), late-onset septicemia (LOS), and necrotizing enterocolitis (NEC). Ten HR-SpO2 measures were analyzed, with first 12 hours data used for predicting death or sIVH and first 7 days for the other outcomes. HR-SpO2 models were combined with clinical models to develop a pulse oximetry predictive score (POPS). Net reclassification improvement (NRI) compared performance of POPS with the clinical predictive score.

Results Models using clinical or pulse oximetry variables alone performed well for each outcome. POPS performed better than clinical variables for predicting death, sIVH, and BPD (NRI > 0.5, p < 0.01), but not tROP, LOS, or NEC.

Conclusion Analysis of early HR-SpO2 characteristics adds to clinical risk factors to predict later adverse outcomes in VLBW infants.

Keywords

prematurity - pulse oximetry - bronchopulmonary dysplasia - intraventricular hemorrhage - sepsis - necrotizing enterocolitis - retinopathy of prematurity - predictive score
 

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