65: Morbidity Free Survival in Premature Neonates Born at Less than 30 Weeks Gestation in Canada Over the Last Decade
Bibliographic record
Abstract
Advances in perinatal-neonatal care over the last 30 years have significantly reduced mortality rates of extremely premature neonates. As the gestational age (GA) at birth increases, morbidity rates at discharge decrease. The distribution of morbidity free survival (MFS) for neonates born extremely premature in Canada is presently unknown. Estimate MFS by GA among extremely premature neonates. Identify the lowest GA at which survival without moderate or severe morbidities (MFS) at discharge is possible and the associated maternal and neonatal characteristics at this GA. Compare MFS rates between genders. This retrospective observational study examined data collected prospectively by the Canadian Neonatal Network™ (CNN) on neonates born at 22+0 to 29+6 weeks GA and admitted to neonatal intensive care units participating in the CNN from 2003 to 2012. Neonates who were moribund on admission, had major congenital anomalies or missing information were excluded. Survival and MFS (survival free of all five major short term morbidities, ie, lung injury, brain injury, necrotizing enterocolitis, retinopathy of prematurity and nosocomial infection) rates were calculated for each GA. At the lowest GA with MFS, maternal and neonatal characteristics were assessed for association with MFS by Chi-square or Fisher exact test for categorical variables and t-test for continuous measures. Similar analyses compared MFS between genders at each GA. Study subjects included 16,312 neonates. The lowest GA at which MFS is possible was 23 weeks (4.6% [95% CI 2.7% to 6.5%]). The largest, 2.3-fold relative increase in MFS rates occurred between 24 and 25 weeks GA. Subsequently, MFS increased linearly each week up to 29 weeks GA (Figure 1). Factors predictive of MFS at 23 weeks GA included cesarean section delivery, maternal antibiotics and maternal hypertension (P=0.03). Antenatal steroids (P=0.07) and female gender (P=0.08) may also impact MFS. Females had higher MFS rates at 25, 27, 28 (P<0.01) and 29 (P<0.001) weeks GA. The lowest GA at which MFS is possible in Canada is 23 weeks. In addition to antenatal steroids and maternal antibiotics, maternal hypertension was also associated with MFS at this GA. Females had higher MFS rates after 24 weeks GA. Future studies are needed to explore the long term neurodevelopmental outcomes of morbidity free survivors on a national scale. This may help to guide clinicians and parents in critical care decision making.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".