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Improving accuracy of outcome prediction for infants born extremely preterm using a digital tool: Translating 'NIC-PREDICT' into clinical practice, the first steps.
Boland, Rosemarie A; Cheong, Jeanie L Y; Stewart, Michael J; Kane, Stefan C; Doyle, Lex W.
Afiliación
  • Boland RA; Clincial Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
  • Cheong JLY; Department of Obstetrics, Gynaecology, and Newborn Health, University of Melbourne, Melbourne, Victoria, Australia.
  • Stewart MJ; Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Melbourne, Victoria, Australia.
  • Kane SC; Clincial Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
  • Doyle LW; Department of Obstetrics, Gynaecology, and Newborn Health, University of Melbourne, Melbourne, Victoria, Australia.
Aust N Z J Obstet Gynaecol ; 64(4): 383-389, 2024 08.
Article en En | MEDLINE | ID: mdl-39102221
ABSTRACT

BACKGROUND:

Many clinicians overestimate mortality and disability rates in infants born extremely preterm. We developed a digital tool ('NIC-PREDICT') that predicts infant mortality and survival with and without major disability in infants born 23-27 weeks' gestation.

AIMS:

To determine if clinicians could use NIC-PREDICT accurately, and if their perceptions of infant outcomes improved after its release in 2021. MATERIALS AND

METHODS:

Midwives, nurses, obstetricians, neonatologists and paediatricians working in tertiary and non-tertiary hospitals in Victoria were asked to use NIC-PREDICT to estimate three mutually exclusive

outcomes:

(i) mortality; (ii) survival free of major disability; and (iii) survival with major disability for six different scenarios where a liveborn infant was offered survival-focused care after birth. The proportions who completed the survey (responded to all six scenarios) and the proportions able to provide 100% accurate results for all scenarios were determined. Estimates of the three outcomes were compared with true rates.

RESULTS:

A total of 85 clinicians responded 70 (82%) completed the survey, with an overall accuracy of 76%. Overall, predictions of mortality were accurate (mean difference from true value 0.7% (95% confidence interval (CI) -0.7, 2.1) P = 0.33), as were predictions of survival without major disability (mean difference - 0.7 (95% CI -3.0, 1.7) P = 0.58). However, survival with major disability was overestimated by 4.9% ((95% CI 1.7, 8.0) P = 0.003).

CONCLUSIONS:

Most perinatal clinicians who responded used NIC-PREDICT correctly to estimate expected outcomes in infants born extremely preterm who are offered intensive care. Undue pessimism about survival with major disability remains an ongoing concern.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Mortalidad Infantil / Recien Nacido Extremadamente Prematuro Límite: Female / Humans / Infant / Newborn / Pregnancy País/Región como asunto: Oceania Idioma: En Revista: Aust N Z J Obstet Gynaecol Año: 2024 Tipo del documento: Article País de afiliación: Australia

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Mortalidad Infantil / Recien Nacido Extremadamente Prematuro Límite: Female / Humans / Infant / Newborn / Pregnancy País/Región como asunto: Oceania Idioma: En Revista: Aust N Z J Obstet Gynaecol Año: 2024 Tipo del documento: Article País de afiliación: Australia
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