Abstract
PurposeWhite matter damage (WMD) was defined as the appearance of rough and uneven echo enhancement in the white matter around the ventricle. The aim of this study was to develop and validate a risk prediction model for neonatal WMD.Materials and MethodsWe collected data for 1,733 infants hospitalized at the Department of Neonatology at The First Affiliated Hospital of Zhengzhou University from 2017 to 2020. Infants were randomly assigned to training (n = 1,216) or validation (n = 517) cohorts at a ratio of 7:3. Multivariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression analyses were used to establish a risk prediction model and web-based risk calculator based on the training cohort data. The predictive accuracy of the model was verified in the validation cohort.ResultsWe identified four variables as independent risk factors for brain WMD in neonates by multivariate logistic regression and LASSO analysis, including gestational age, fetal distress, prelabor rupture of membranes, and use of corticosteroids. These were used to establish a risk prediction nomogram and web-based calculator (https://caowenjun.shinyapps.io/dynnomapp/). The C-index of the training and validation sets was 0.898 (95% confidence interval: 0.8745–0.9215) and 0.887 (95% confidence interval: 0.8478–0.9262), respectively. Decision tree analysis showed that the model was highly effective in the threshold range of 1–61%. The sensitivity and specificity of the model were 82.5 and 81.7%, respectively, and the cutoff value was 0.099.ConclusionThis is the first study describing the use of a nomogram and web-based calculator to predict the risk of WMD in neonates. The web-based calculator increases the applicability of the predictive model and is a convenient tool for doctors at primary hospitals and outpatient clinics, family doctors, and even parents to identify high-risk births early on and implementing appropriate interventions while avoiding excessive treatment of low-risk patients.
Highlights
The survival of newborns with serious disease has significantly improved in recent years as a result of advances in neonatal intensive care (Cheng et al, 2015); the occurrence of sequelae in surviving children that can affect their physical and mental development has increased, placing a burden on their families and society
Data collected from the medical records of the mother and infant included sex, cesarean delivery, gestational age (GA), birth weight (BW), multiple pregnancies, Apgar 1- and 5-min scores, placental abnormalities, abnormal umbilical cord, amniotic fluid anomalies, hypertension, gestational diabetes mellitus, treatments during pregnancy, prelabor rupture of membranes (PROM), maternal age, embryo transfer, adverse pregnancy history, cardiac dysfunction, and use of corticosteroids (CS)
Previous studies have shown that lower GA is associated with an increased risk of white matter damage (WMD) resulting from lack of maturation of blood vessels supplying the brain white matter and long and short perforating branches of the middle cerebral artery; almost no anastomoses in the cerebrovasculature; and absence of automatic adjustment thereof during development, which decreases systemic blood pressure and leads to passive-pressure cerebral circulation (Dammann et al, 2002; Nosarti et al, 2004; Leviton and Gressens, 2007; Rees et al, 2011; Mao et al, 2020)
Summary
The survival of newborns with serious disease has significantly improved in recent years as a result of advances in neonatal intensive care (Cheng et al, 2015); the occurrence of sequelae in surviving children that can affect their physical and mental development has increased, placing a burden on their families and society. The periventricular echodensity (PVE) 1 level occurs when the echogenicity of the white matter around the ventricle is enhanced to be as bright as choroid plexus. The echo intensity of periventricular white matter was higher than that of the choroid plexus, PVE2 (Resch et al, 2006). When no abnormality or only slight echogenicity is observed in the cranial ultrasound scan for a period of less than 1 week, the enhanced echogenicity may be caused by venous congestion (De Vries et al, 1988; de Vries et al, 1992) or simple immaturity (Resch et al, 2006), which has little impact on the long-term prognosis of neonates. Its prognosis cannot be ignored (Resch et al, 2006)
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