629 A new predictive model for periviable infant survival

Abstract

Currently available survival calculators for periviable births do not account for fetal presentation and mode of delivery. We set out to develop and validate a predictive risk calculator for infant survival among women who delivered between 22 0/7 – 25 6/7 weeks of gestation which accounts for mode of delivery and fetal presentation. We performed a population-based cohort study of all women with livebirths between 22 0/7 – 25 6/7 weeks of gestation in the United States from 2009 through 2013. The primary objective was to build a predictive model estimating the probability of infant survival at 12 months of age using antenatal factors obtained from de-identified U.S livebirth records. Multivariable logistic regression estimated the association of these factors on risk of infant survival. A publicly available online calculator was developed after external validation and calibration were performed for individual risk assessment. The eight variables selected for inclusion in the model by magnitude of influence on infant survival were birthweight, gestational age, sex, antenatal steroid exposure, resuscitation, presentation at birth, mode of delivery and multifetal gestation From 2009-2013, there were 67,260 liveborn infants in the U.S. between 22 0/7 – 25 6/7 weeks of gestation, of which 51,352 were included in the study cohort. The receiver operator characteristic (ROC) curve for the 8-variable model achieved an area under the curve of 0.800 (95% CI 0.795-0.804). External validation demonstrated a consistent measure of discrimination with an AUC of 0.799 (95% CI 0.789-0.808). This validated predictive model accounts for new variables obtainable from the medical record and discriminates between infants at increased or decreased risk of survival after periviable birth. This risk calculator found at https://stage.ob.tools/calc/elbw (username: [email protected] , password: personalizeCare) and can utilized by health care providers in counseling women with threatening periviable birth.View Large Image Figure ViewerDownload Hi-res image Download (PPT)