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  • Original Article
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The impact of maternal characteristics on the moderately premature infant: an antenatal maternal transport clinical prediction rule

Journal of Perinatology volume 32, pages 532–538 (2012)Cite this article

A Corrigendum to this article was published on 29 April 2013

Abstract

Objective:

Moderately premature infants, defined here as those born between and weeks gestation, comprise 3.9% of all births in the United States and 32% of all preterm births. Although long-term outcomes for these infants are better than for less mature infants, morbidity and mortality are still substantially increased in comparison with infants born at term. There is an added survival benefit resulting from birth at a tertiary neonatal care center, and although many of these infants require tertiary level care, delivery at lower level hospitals and subsequent neonatal transfer are still common. Our primary aim was to determine the impact of maternal characteristics and antenatal medical management on the early neonatal course of the moderately premature infant. The secondary aim was to create a clinical prediction rule to determine which infants require intubation and mechanical ventilation in the first 24 h of life. Such a prediction rule could inform the decision to transfer maternal–fetal patients before delivery to a facility with a Level III neonatal intensive care unit (NICU), where optimal care could be provided without the requirement for a neonatal transfer.

Study Design:

Data for this analysis came from the cohort of infants in the Moderately Premature Infant Project (MPIP) database, a multicenter cohort study of 850 infants born at gestational age and weeks, with birth weight between 1500 and 2499 g, who were discharged to home alive. We built a logistic regression model to identify maternal characteristics associated with need for tertiary care, as measured by administration of surfactant. Using statistically significant covariates from this model, we then created a numerical decision rule to predict need for tertiary care.

Result:

In multivariate modeling, four factors were associated with reduction in the need for tertiary care, including non-White race (odds ratio (OR)=0.5, (0.3, 0.7)), older gestational age, female gender (OR=0.6 (0.4, 0.8)) and use of antenatal corticosteroids (OR=0.5, (0.3, 0.8)). The clinical prediction rule to discriminate between infants who received surfactant, versus those who did not, had an area under the curve of 0.77 (0.73, 0.8).

Conclusion:

Four antenatal risk factors are associated with a requirement for Level III NICU care as defined by the need for surfactant administration. Future analyses will examine a broader spectrum of antenatal characteristics and revalidate the prediction rule in an independent cohort.

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Acknowledgements

The original data collection for MPIP was funded by the Agency for Health Care Research and Quality (RO1 HS 10131). Dr Dukhovny's work on this project was supported in part by the AHRQ T32 HS000063 Training Grant (2009 to 2010) and the National Institutes of Health Loan Repayment Program (2010 to 2012). We thank John D Greene from Kaiser Permanente for his statistical support on this project.

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Authors and Affiliations

  1. Division of Newborn Medicine, Harvard Medical School, Boston, MA, USA

    D Dukhovny, D M Pursley, M C McCormick & J A F Zupancic

  2. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    D Dukhovny, D M Pursley, M C McCormick, W Y Mao & J A F Zupancic

  3. Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA

    S Dukhovny

  4. Division of Research, Regional Director for Hospital Operations Research, Kaiser Permanente Medical Care Program, Oakland, CA, USA

    G J Escobar

  5. Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA

    M C McCormick

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  1. D Dukhovny
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Correspondence to D Dukhovny.

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Dukhovny, D., Dukhovny, S., Pursley, D. et al. The impact of maternal characteristics on the moderately premature infant: an antenatal maternal transport clinical prediction rule. J Perinatol 32, 532–538 (2012). https://doi.org/10.1038/jp.2011.155

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