A simple scoring system for prediction of IVH in very-low-birth-weight infants.

Abstract

To develop a simple scoring system to predict either any or severe IVH in VLBW infants. In this retrospective cohort study, 923 VLBW infants were randomly divided into derivation (n = 431) and validation (n = 492) cohorts. After stepwise multivariable logistic regression analyses, a risk score was assigned to independent predictors. The overall rates of any and severe IVH were 22.9% and 9.9%. Gestational age, maternal race, location of birth and sex were independent predictors of any IVH (AUC 0.75 in derivation cohort and 0.69 for validation cohort). Birth weight, Apgar score at 1 minute, location of birth and sex were independent predictors of severe IVH (AUC 0.84 in derivation cohort and 0.77 for validation cohort). For any IVH, infants in the high-risk category (total score 4 or 5) had > 50% likelihood of any IVH with a negative predictive value of 82.6%. For severe IVH, the total risk score ranged from 0-8, and infants in high-risk category (total score 6-8) had 30% likelihood of severe IVH with a negative predictive value of 94.9%. We report an easy to calculate, validated scoring system with a high NPV to identify VLBW infants at highest risk of IVH. We report a simple validated scoring system with a high NPV for prediction of IVH in VLBW infants. The variables in the proposed model are available at birth and unlikely to be influenced by provider bias. This scoring system can identify infants at risk of any and severe IVH, while most previous models predict only severe IVH. This scoring system does not require access to web-based resources. This scoring system can help in employing prevention strategies only for infants at highest risk of IVH and thus eliminate the risks of interventions in a large majority of VLBW infants.