Predicting mortality risk for infants weighing 501 to 1500 grams at birth: A National Institutes of Health Neonatal Research Network report

J. D. Horbar, L. Onstad, E. Wright, S. J. Yaffe, C. Catz, L. L. Wright, Michael Malloy, G. G. Rhoades, T. Gordon, E. Phillips, W. Oh, G. Cassady, J. Philips, J. F. Lucey, A. A. Fanaroff, M. Hack, J. E. Tyson, R. Uauy, R. Poland

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

Objectives: To develop and evaluate a model that predicts mortality risk based on admission data for infants weighing 501 to 1500 grams at birth, and to use the model to identify neonatal ICUs where the observed mortality rate differs significantly from the predicted rate. Design: Validation cohort study. Setting: University-based, tertiary care neonatal ICUs. Patients: Sample of 3,603 infants with birth weights of 501 to 1500 grams who were born at seven National Institute of Child Health and Human Development (NICHHD) Neonatal Research Network Centers, over a 2-yr period of time. Interventions: None. Measurements and Main Results: Based on logistic regression analysis, admission factors associated with mortality risk for inborn infants were: decreasing birth weight, appropriate size for gestational age, male gender, non-black race, and 1-min Apgar score of ≤3. The mortality prediction model based on these factors had a sensitivity of 0.50, a specificity of 0.92, a correct classification rate of 0.82, and an area under the receiver operating characteristic curve of 0.82 when applied to a validation sample. Goodness- of-fit testing showed that there was a marginal degree of fit between the observations and model predictions (χ2 = 15.4, p = .06). The observed mortality rate for 3,603 infants at the seven centers was 24.7%, ranging from 21.8% to 27.7% at individual centers. There were no statistically significant differences between observed and predicted mortality rates at any of the centers. One center had an observed mortality rate that was 2.8% lower than predicted by the model (95% confidence interval -6.0% to 0.5%), and another center had an observed rate that was 3% higher than expected (95% confidence interval -0.3% to 6.2%). Conclusions: Mortality risk for infants weighing 501 to 1500 grams can be predicted based on admission factors. However, until more accurate predictive models are developed and validated and the relationships between care practices and outcomes are better understood, such models should not be relied on for evaluating the quality of care provided in different neonatal ICUs.

Original languageEnglish (US)
Pages (from-to)12-18
Number of pages7
JournalCritical Care Medicine
Volume21
Issue number1
StatePublished - 1993
Externally publishedYes

Fingerprint

National Institutes of Health (U.S.)
Infant Mortality
Parturition
Mortality
Neonatal Intensive Care Units
Birth Weight
National Institute of Child Health and Human Development (U.S.)
Confidence Intervals
Apgar Score
Quality of Health Care
Validation Studies
Tertiary Healthcare
ROC Curve
Gestational Age
Cohort Studies
Logistic Models
Regression Analysis
Research

Keywords

  • critical illness
  • healthcare research
  • infant low birth weight
  • intensive care
  • mortality
  • neonate
  • patient outcome assessment
  • pediatrics
  • prognostication
  • quality of health care
  • receiver operating characteristic

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Horbar, J. D., Onstad, L., Wright, E., Yaffe, S. J., Catz, C., Wright, L. L., ... Poland, R. (1993). Predicting mortality risk for infants weighing 501 to 1500 grams at birth: A National Institutes of Health Neonatal Research Network report. Critical Care Medicine, 21(1), 12-18.

Predicting mortality risk for infants weighing 501 to 1500 grams at birth : A National Institutes of Health Neonatal Research Network report. / Horbar, J. D.; Onstad, L.; Wright, E.; Yaffe, S. J.; Catz, C.; Wright, L. L.; Malloy, Michael; Rhoades, G. G.; Gordon, T.; Phillips, E.; Oh, W.; Cassady, G.; Philips, J.; Lucey, J. F.; Fanaroff, A. A.; Hack, M.; Tyson, J. E.; Uauy, R.; Poland, R.

In: Critical Care Medicine, Vol. 21, No. 1, 1993, p. 12-18.

Research output: Contribution to journalArticle

Horbar, JD, Onstad, L, Wright, E, Yaffe, SJ, Catz, C, Wright, LL, Malloy, M, Rhoades, GG, Gordon, T, Phillips, E, Oh, W, Cassady, G, Philips, J, Lucey, JF, Fanaroff, AA, Hack, M, Tyson, JE, Uauy, R & Poland, R 1993, 'Predicting mortality risk for infants weighing 501 to 1500 grams at birth: A National Institutes of Health Neonatal Research Network report', Critical Care Medicine, vol. 21, no. 1, pp. 12-18.
Horbar, J. D. ; Onstad, L. ; Wright, E. ; Yaffe, S. J. ; Catz, C. ; Wright, L. L. ; Malloy, Michael ; Rhoades, G. G. ; Gordon, T. ; Phillips, E. ; Oh, W. ; Cassady, G. ; Philips, J. ; Lucey, J. F. ; Fanaroff, A. A. ; Hack, M. ; Tyson, J. E. ; Uauy, R. ; Poland, R. / Predicting mortality risk for infants weighing 501 to 1500 grams at birth : A National Institutes of Health Neonatal Research Network report. In: Critical Care Medicine. 1993 ; Vol. 21, No. 1. pp. 12-18.
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abstract = "Objectives: To develop and evaluate a model that predicts mortality risk based on admission data for infants weighing 501 to 1500 grams at birth, and to use the model to identify neonatal ICUs where the observed mortality rate differs significantly from the predicted rate. Design: Validation cohort study. Setting: University-based, tertiary care neonatal ICUs. Patients: Sample of 3,603 infants with birth weights of 501 to 1500 grams who were born at seven National Institute of Child Health and Human Development (NICHHD) Neonatal Research Network Centers, over a 2-yr period of time. Interventions: None. Measurements and Main Results: Based on logistic regression analysis, admission factors associated with mortality risk for inborn infants were: decreasing birth weight, appropriate size for gestational age, male gender, non-black race, and 1-min Apgar score of ≤3. The mortality prediction model based on these factors had a sensitivity of 0.50, a specificity of 0.92, a correct classification rate of 0.82, and an area under the receiver operating characteristic curve of 0.82 when applied to a validation sample. Goodness- of-fit testing showed that there was a marginal degree of fit between the observations and model predictions (χ2 = 15.4, p = .06). The observed mortality rate for 3,603 infants at the seven centers was 24.7{\%}, ranging from 21.8{\%} to 27.7{\%} at individual centers. There were no statistically significant differences between observed and predicted mortality rates at any of the centers. One center had an observed mortality rate that was 2.8{\%} lower than predicted by the model (95{\%} confidence interval -6.0{\%} to 0.5{\%}), and another center had an observed rate that was 3{\%} higher than expected (95{\%} confidence interval -0.3{\%} to 6.2{\%}). Conclusions: Mortality risk for infants weighing 501 to 1500 grams can be predicted based on admission factors. However, until more accurate predictive models are developed and validated and the relationships between care practices and outcomes are better understood, such models should not be relied on for evaluating the quality of care provided in different neonatal ICUs.",
keywords = "critical illness, healthcare research, infant low birth weight, intensive care, mortality, neonate, patient outcome assessment, pediatrics, prognostication, quality of health care, receiver operating characteristic",
author = "Horbar, {J. D.} and L. Onstad and E. Wright and Yaffe, {S. J.} and C. Catz and Wright, {L. L.} and Michael Malloy and Rhoades, {G. G.} and T. Gordon and E. Phillips and W. Oh and G. Cassady and J. Philips and Lucey, {J. F.} and Fanaroff, {A. A.} and M. Hack and Tyson, {J. E.} and R. Uauy and R. Poland",
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T2 - A National Institutes of Health Neonatal Research Network report

AU - Horbar, J. D.

AU - Onstad, L.

AU - Wright, E.

AU - Yaffe, S. J.

AU - Catz, C.

AU - Wright, L. L.

AU - Malloy, Michael

AU - Rhoades, G. G.

AU - Gordon, T.

AU - Phillips, E.

AU - Oh, W.

AU - Cassady, G.

AU - Philips, J.

AU - Lucey, J. F.

AU - Fanaroff, A. A.

AU - Hack, M.

AU - Tyson, J. E.

AU - Uauy, R.

AU - Poland, R.

PY - 1993

Y1 - 1993

N2 - Objectives: To develop and evaluate a model that predicts mortality risk based on admission data for infants weighing 501 to 1500 grams at birth, and to use the model to identify neonatal ICUs where the observed mortality rate differs significantly from the predicted rate. Design: Validation cohort study. Setting: University-based, tertiary care neonatal ICUs. Patients: Sample of 3,603 infants with birth weights of 501 to 1500 grams who were born at seven National Institute of Child Health and Human Development (NICHHD) Neonatal Research Network Centers, over a 2-yr period of time. Interventions: None. Measurements and Main Results: Based on logistic regression analysis, admission factors associated with mortality risk for inborn infants were: decreasing birth weight, appropriate size for gestational age, male gender, non-black race, and 1-min Apgar score of ≤3. The mortality prediction model based on these factors had a sensitivity of 0.50, a specificity of 0.92, a correct classification rate of 0.82, and an area under the receiver operating characteristic curve of 0.82 when applied to a validation sample. Goodness- of-fit testing showed that there was a marginal degree of fit between the observations and model predictions (χ2 = 15.4, p = .06). The observed mortality rate for 3,603 infants at the seven centers was 24.7%, ranging from 21.8% to 27.7% at individual centers. There were no statistically significant differences between observed and predicted mortality rates at any of the centers. One center had an observed mortality rate that was 2.8% lower than predicted by the model (95% confidence interval -6.0% to 0.5%), and another center had an observed rate that was 3% higher than expected (95% confidence interval -0.3% to 6.2%). Conclusions: Mortality risk for infants weighing 501 to 1500 grams can be predicted based on admission factors. However, until more accurate predictive models are developed and validated and the relationships between care practices and outcomes are better understood, such models should not be relied on for evaluating the quality of care provided in different neonatal ICUs.

AB - Objectives: To develop and evaluate a model that predicts mortality risk based on admission data for infants weighing 501 to 1500 grams at birth, and to use the model to identify neonatal ICUs where the observed mortality rate differs significantly from the predicted rate. Design: Validation cohort study. Setting: University-based, tertiary care neonatal ICUs. Patients: Sample of 3,603 infants with birth weights of 501 to 1500 grams who were born at seven National Institute of Child Health and Human Development (NICHHD) Neonatal Research Network Centers, over a 2-yr period of time. Interventions: None. Measurements and Main Results: Based on logistic regression analysis, admission factors associated with mortality risk for inborn infants were: decreasing birth weight, appropriate size for gestational age, male gender, non-black race, and 1-min Apgar score of ≤3. The mortality prediction model based on these factors had a sensitivity of 0.50, a specificity of 0.92, a correct classification rate of 0.82, and an area under the receiver operating characteristic curve of 0.82 when applied to a validation sample. Goodness- of-fit testing showed that there was a marginal degree of fit between the observations and model predictions (χ2 = 15.4, p = .06). The observed mortality rate for 3,603 infants at the seven centers was 24.7%, ranging from 21.8% to 27.7% at individual centers. There were no statistically significant differences between observed and predicted mortality rates at any of the centers. One center had an observed mortality rate that was 2.8% lower than predicted by the model (95% confidence interval -6.0% to 0.5%), and another center had an observed rate that was 3% higher than expected (95% confidence interval -0.3% to 6.2%). Conclusions: Mortality risk for infants weighing 501 to 1500 grams can be predicted based on admission factors. However, until more accurate predictive models are developed and validated and the relationships between care practices and outcomes are better understood, such models should not be relied on for evaluating the quality of care provided in different neonatal ICUs.

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KW - mortality

KW - neonate

KW - patient outcome assessment

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KW - prognostication

KW - quality of health care

KW - receiver operating characteristic

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