Early prediction of neonatal chronic lung disease: A comparison of three scoring methods

A variety of postnatal therapies have been and will be evaluated for preven tion or treatment of neonatal chronic lung disease (CLD). A simple method f or early selection of the highest risk infants would optimize intervention trials. Our study compared a clinical scoring system for predicting neonata l CLD (defined at 36 weeks postconceptional age) with previous regression m odels developed by Sinkin et al. (Sinkin model) [Pediatrics 1990:86:728-736 ] and Ryan et at. (Ryan model) [Eur J Pediatr 1996;668-671] in two distinct populations. A respiratory failure score (RFS) was prospectively developed for infants at <32 weeks of gestation admitted to the Wilford Hall Medical Center from January 1990-December 1992. Logistic regression modeling ident ified three independent predictors of CLD: gestation, birth weight, and RFS . Applying a modified RFS score (to include gestation and birth weight), th e RFS, Sinkin, and Ryan models were compared among high-risk infants admitt ed to Wilford Hall from January 1993-December 1995, and to Crawford Long Ho spital (Atlanta, GA) from January 1993-December 1994. Predictive values, se nsitivity, specificity, and receiver operating characteristic (ROC) curves were determined for the primary outcome variable: OLD at 36 weeks of correc ted gestation. Of 248 infants at <32 weeks admitted to Wilford Hall, 220 survived >7 days. Thirty of 31 (97%) infants diagnosed with CLD were less than or equal to 2 9 weeks or less than or equal to 1,000 g at birth. Despite important demogr aphic and treatment differences between the study populations, similar ROC curves were found for each scoring method when individually evaluated among the three study groups. The RFS method at 72 h demonstrated the greatest a rea under the ROC curve for prediction of neonatal CLD in the groups as a w hole. Application of the RFS method for early prediction of neonatal CLD at age 72 h should improve patient selection for early prevention trials. Ped iatr Pulmonol, 1999; 27:388-394. Published 1999 Wiley-Liss, Inc.dagger