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Disease severity markers predicting adverse outcome in term infants with respiratory failure

Presented at the Neonatal Society 2001 Summer Meeting (programme).

Bennett CC1, Johnson A2, Field DJ3.
On behalf of the UK Collaborative ECMO Trial Group.

1 John Radcliffe Hospital, Oxford, UK
NPEU, University of Oxford, UK
Leicester University, Leicester, UK

Objective: To determine clinical variables predicting outcome in a group of 185 infants born at 35 weeks gestational age or above who developed severe respiratory failure defined by oxygenation index equal to or greater than 40.

Methods: A variety of disease severity markers were selected and the association between the chosen variable and outcome was determined. Adverse outcome was defined by death or disability at four years of age in survivors. Receiver operator characteristic (ROC) plots were constructed for variables with continuous data and relative risk (RR) with 95% confidence intervals (CI) calculated for binominal data.

Results: Clinical variables predicting mortality and disability at 4 years:

Clinical variable
Congenital diaphragmatic hernia
Birthweight less than 3kg
Continued conventional care, ie. not ECMO

RR (95% CI), p value
1.38 (1.22-1.56), p<0.001
1.34 (1.16-1.54), p<0.001
1.84 (1.14-2.97), p=0.003

Clinical variables predicting disability at 4 years in survivors:

Clinical variable
Seizures requiring treatment
Sepsis - documented or suspected
Full sucking feeding at over 14 days of age
Days in hospital over 30 days
Supplementary oxygen at discharge

RR (95% CI), p value
2.02 (1.63-2.51), p=0.002
1.58 (1.09-2.30), p=0.01
6.47 (2.24-19.2), p<0.001
1.79 (1.22-2.61), p=0.02
1.91 (1.57-2.34), p=0.02

Conclusions: This study has identified clinical variables that predict adverse outcome for term infants with severe respiratory failure. The results could assist clinicians caring for these babies and when counselling their families.

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