OBJECTIVES: For a cohort of extremely premature, ventilated, newborn infants, we determined the power of either serial caretaker intuitions of "die before discharge" or serial illness severity scores to predict the outcomes of death in the NICU or neurologic performance at corrected age of 2 years. METHODS: We identified 268 premature infants who were admitted to our NICU in 1999-2004 and required mechanical ventilation. For each infant on each day of mechanical ventilation, we asked nurses, residents, fellows, and attending physicians the following question: "Do you think this child is going to live to go home or die before hospital discharge?" In addition, we calculated illness severity scores until either death or extubation. RESULTS: A total of 17,066 intuition profiles were obtained on 5609 days of mechanical ventilation in the NICU. One hundred (37%) of 268 profiled infants had > or = 1 intuition of die before discharge. Only 33 infants (33%) with an intuition of die actually died in the NICU. Of 48 infants with even 1 day of corroborated intuition of die in the NICU, only 7 (14%) were alive with both Mental Developmental Index and Psychomotor Developmental Index scores of > 69, and only 2 (4%) were alive with both Mental Developmental Index and Psychomotor Developmental Index Scores of > 79 at corrected age of 2 years. On day of life 1, the Score for Neonatal Acute Physiology II value for nonsurvivors (38.2 +/- 18.1) was significantly higher than that for survivors (26.3 +/- 12.7). However, this difference decreased steadily over time as scores improved for both groups. CONCLUSIONS: Illness severity scores become progressively less helpful over time in distinguishing infants who will either die in the NICU or survive with low Mental Developmental Index/Psychomotor Developmental Index scores. Serial caretaker intuitions of die before discharge also fail to identify prospective nonsurviving infants. However, corroborated intuitions of die before discharge identify a subset of infants whose likelihood of surviving to 2 years with both MDI and PDI > 80 is approximately 4%.
OBJECTIVES: For a cohort of extremely premature, ventilated, newborn infants, we determined the power of either serial caretaker intuitions of "die before discharge" or serial illness severity scores to predict the outcomes of death in the NICU or neurologic performance at corrected age of 2 years. METHODS: We identified 268 premature infants who were admitted to our NICU in 1999-2004 and required mechanical ventilation. For each infant on each day of mechanical ventilation, we asked nurses, residents, fellows, and attending physicians the following question: "Do you think this child is going to live to go home or die before hospital discharge?" In addition, we calculated illness severity scores until either death or extubation. RESULTS: A total of 17,066 intuition profiles were obtained on 5609 days of mechanical ventilation in the NICU. One hundred (37%) of 268 profiled infants had > or = 1 intuition of die before discharge. Only 33 infants (33%) with an intuition of die actually died in the NICU. Of 48 infants with even 1 day of corroborated intuition of die in the NICU, only 7 (14%) were alive with both Mental Developmental Index and Psychomotor Developmental Index scores of > 69, and only 2 (4%) were alive with both Mental Developmental Index and Psychomotor Developmental Index Scores of > 79 at corrected age of 2 years. On day of life 1, the Score for Neonatal Acute Physiology II value for nonsurvivors (38.2 +/- 18.1) was significantly higher than that for survivors (26.3 +/- 12.7). However, this difference decreased steadily over time as scores improved for both groups. CONCLUSIONS: Illness severity scores become progressively less helpful over time in distinguishing infants who will either die in the NICU or survive with low Mental Developmental Index/Psychomotor Developmental Index scores. Serial caretaker intuitions of die before discharge also fail to identify prospective nonsurviving infants. However, corroborated intuitions of die before discharge identify a subset of infants whose likelihood of surviving to 2 years with both MDI and PDI > 80 is approximately 4%.
Authors: Namasivayam Ambalavanan; Waldemar A Carlo; Jon E Tyson; John C Langer; Michele C Walsh; Nehal A Parikh; Abhik Das; Krisa P Van Meurs; Seetha Shankaran; Barbara J Stoll; Rosemary D Higgins Journal: Pediatrics Date: 2012-06-11 Impact factor: 7.124
Authors: Jennifer James; David Munson; Sara B DeMauro; John C Langer; April R Dworetz; Girija Natarajan; Margarita Bidegain; Christine A Fortney; Ruth Seabrook; Betty R Vohr; Jon E Tyson; Edward F Bell; Brenda B Poindexter; Seetha Shankaran; Rosemary D Higgins; Abhik Das; Barbara J Stoll; Haresh Kirpalani Journal: J Pediatr Date: 2017-06-21 Impact factor: 4.406
Authors: Orlyn C Lavilla; Khyzer B Aziz; Allison C Lure; Daniel Gipson; Diomel de la Cruz; James L Wynn Journal: Am J Respir Crit Care Med Date: 2022-01-01 Impact factor: 21.405
Authors: Christoph P Hornik; Eric M Graham; Kevin Hill; Jennifer S Li; George Ofori-Amanfo; Reese H Clark; P Brian Smith Journal: Early Hum Dev Date: 2016-07-09 Impact factor: 2.699
Authors: Christoph P Hornik; Ashley L Sherwood; C Michael Cotten; Matthew M Laughon; Reese H Clark; P Brian Smith Journal: Early Hum Dev Date: 2016-03-25 Impact factor: 2.699