학술논문
External Validation of a Multivariate Model for Targeted Surfactant Replacement.
Document Type
Article
Author
Raimondi, Francesco; Dolce, Pasquale; Veropalumbo, Claudio; Sierchio, Enrico; Gregorio Hernandez, Rebeca; Rodriguez Fanjul, Javier; Meneghin, Fabio; Raschetti, Roberto; Bonadies, Luca; Corsini, Iuri; Alonso Ojembarrena, Almudena; Salomè, Serena; Rodeño Fernandez, Lorena; Sanchez Luna, Manuel; Lista, Gianluca; Mosca, Fabio; Dani, Carlo; Baraldi, Eugenio; Giordano, Lucio; Davis, Peter G
Source
Subject
*SURFACE active agents
*RESPIRATORY distress syndrome
*PREMATURE infants
*MODEL validation
*OXYGEN saturation
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Language
ISSN
1661-7800
Abstract
Introduction: Early targeted surfactant therapy for preterm infants is recommended but the best criteria to personalize treatment are unclear. We validate a previously published multivariate prognostic model based on gestational age (GA), lung ultrasound score (LUS), and oxygen saturation to inspire oxygen fraction ratio (SatO2/FiO2) using an independent data set. Methods: Pragmatic, observational study in 10 Italian and Spanish NICUs, including preterm babies (250 and 336 weeks divided into 3 GA intervals) with clinical signs of respiratory distress syndrome and stabilized on CPAP. LUS and SatO2/FiO2 were collected soon after stabilization. Their prognostic accuracy was evaluated on the subsequent surfactant administration by a rigorously masked physician. Results: One hundred seventy-five infants were included in the study. Surfactant was given to 74% infants born at 25–27 weeks, 38.5% at 28–30 weeks, and 26.5% at 31–33 weeks. The calibration curve comparing the validation and the development populations showed significant overlap with an intercept = 0.08, 95% CI (−0.34; 0.5) and a slope = 1.53, 95% CI (1.07–1.98). The validation cohort had a high predictive accuracy. Its ROC curve showed an AUC = 0.95, 95% CI (0.91–0.99) with sensitivity = 0.93, 95% CI (0.83–0.98), specificity = 0.81, 95% CI (0.73–0.88), PPV = 0.76, 95% CI (0.65–0.84), NPV = 0.95, 95% CI (0.88–0.98). LUS ≥9 demonstrated the highest sensitivity (0.91, 95% CI [0.82–0.97]) and specificity = 0.81, 95% CI (0.72–0.88) as individual predictor. LUS and SatO2/FiO2 prognostic performances varied with GA. Conclusion: We validated a prognostic model based on LUS and Sat/FiO2 to facilitate early, customized surfactant administration that may improve respiratory management of preterm neonates. [ABSTRACT FROM AUTHOR]