5 Prevention and 18-Month Outcome of Serious Pulmonary Hemorrhage in Extremely-Low-Birth-Weight (ELBW) Infants: Results from the Trial of Indomethacin Prophylaxis in Preterms (TIPP)
Bibliographic record
Abstract
Serious pulmonary hemorrhage (PH) that requires increased respiratory support or transfusion of blood products is associated with significant acute morbidity and mortality in ELBW infants. Long-term outcome is less certain. A patent ductus arteriosus (PDA) is a risk factor for PH. However, despite halving the incidence of PDA, indomethacin prophylaxis (Indo P) did not reduce the overall rate of PH in the TIPP study (N Engl J Med 2001;344:1966). We speculated that a beneficial effect of Indo P on PH may have been masked by the inclusion of mild cases. Using the TIPP database of 1202 ELBW infants, we examined the effect of Indo P on the cumulative risk of serious PH, the role of PDA as a cause of PH and the 18-month outcome of serious PH. The cumulative risk of serious PH was estimated for the first week of life, and for the entire NICU stay (Kaplan-Meier). Cox models examined how much of the Indo P effect on PH was explained by a reduced risk of PDA. Poor outcome at 18 months was defined as death or survival with cerebral palsy, cognitive delay, blindness, or deafness. Indo P reduced the cumulative risk of PH during week 1 by 35% (95% CI 0.04 to 0.57; p=0.033). There was less benefit of Indo P on the cumulative risk of PH during the entire NICU stay: RRR 23% (95% CI −0.10 to 0.46; p=0.153). A reduced risk of PDA explained over 80% of the Indo P effect on PH. Of the 574 infants in the Indo P group with data on the 18-month outcome, 53 had serious PH and 40 (75.5%) died or survived with impairment. Of the 569 infants in the placebo group, 69 had serious PH and 52 (75.4%) had a poor outcome. Among infants without PH, 231/521 (44.3%) had a poor outcome after Indo P as compared with 209/500 (41.8%) after placebo. ELBW infants with serious PH have an increased risk of death or impairment at 18 months. Indo P reduces early serious PH, mainly through its action on PDA. However, any benefit derived from preventing a serious PH in a very small minority of ELBW infants is offset by the apparent small adverse effect of Indo P on the long-term outcome of the majority of ELBW infants who do not develop serious PH.
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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 | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 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".