TOWARD EVIDENCE-BASED PRACTICE

摘要

A Clinical Scoring System to Predict the Need for Extensive Resuscitation at Birth in Very Low Birth Weight Infants Lee, J., & Lee, J. H. (2019). BMC Pediatrics, 19(1), 197. doi:10.1186/sL2887-019-1573-9 The authors of this study developed a prediction model for extensive delivery room resuscitation in very low birth weight (VLBW) infants (defined as weight < 1,500 g). Data to inform the model were drawn from the records of 5,298 VLBW infants who received care in one of 66 NICUs participating in the Korean Neonatal Network (KNN) in South Korea between 2013 and 2015. Extensive resuscitation occurred in 260 (4.9%) of these cases. Lower birth weight, lower gestational age, lower 1- and 5-minute Apgar scores, being outborn, and male sex were associated with extensive resuscitation. Drawing from these associations, the final prediction model for extensive resuscitation included only factors that could be determined before birth: gestational age (<25 weeks is more likely to need extensive resuscitation), amniotic fluid (polyhydramnios is more likely to need extensive resuscitation), and antenatal steroid use (no steroid is more likely to need extensive resuscitation). Of these three factors in the final model, antenatal steroid use is the only modifiable factor. Although this study is one of the first to develop an objective method using multiple variables to predict extensive resuscitation, further work is needed to improve the positive predictive value of the model. If using the model with a cutoff score of 2 to predict assembling a resuscitation team, only 8 of 100 resuscitation teams would be used in an extensive resuscitation.