Voorspellen van sterfte bij zeer premature kinderen*

Objective

To validate in a Dutch setting two British prognostic models which predict the risk of stillbirth and neonatal death in very preterm infants. The children were alive at the onset of labour (model 1) or were admitted to a neonatal intensive care unit (NICU; model 2).

Design

Cohort study.

Method

All infants with a European ethnicity who were born with a gestational age of 22-32 weeks in the Netherlands from 1 January 2000-31 December 2007 were included. In all, 17,582 children were alive at the onset of labour of whom 11,578 were admitted to an NICU. Death was defined as stillbirth or death within 28 days of birth (model 1) or neonatal death before discharge from the NICU (model 2). Model performance was studied with calibration plots and the c statistic.

Results

Of the infants known to be alive at the onset of labour, 2939 (16.7%) died during labour or within 28 days of birth. Of the infants admitted to the NICU, 908 (7.8%) died before discharge. Both models showed good calibration and a good to excellent discrimination: the c statistic (area under the receiver operating characteristic curve, AUC) was 0.92 for model 1 and 0.82 for model 2.

Conclusion

The two British prognostic models predicted the risk of stillbirth and neonatal death well in very preterm Dutch infants. The models are based on characteristics that are easily assessed, such as gender, gestational age, estimated birth weight and plurality of pregnancy, suggesting their use in Dutch gynaecologic and neonatal practices.

Conflict of interest: none declared. Financial support for this article: the institute of B.N. Manktelow has received a grant from the Primary Care Trusts of the East Midlands and Yorkshire regions of the UK.