87 Severe cardiorespiratory events and neurodevelopmental outcomes in extremely preterm infants
Bibliographic record
Abstract
Abstract Background Extremely preterm infants (gestational age [GA] < 28 weeks) have frequent apneas, bradycardias, and desaturations that require tactile stimulation, bag-mask ventilation, and/or intubation. The cumulative impact of these nurse-recorded cardiorespiratory events (CREs) on long-term risk of significant neurodevelopmental impairment (sNDI) is unknown. Objectives To explore associations between severe CREs and sNDI at 18 to 24 months corrected age in extremely preterm infants. Design/Methods In this retrospective cohort study, extremely preterm infants admitted to the Montreal Children’s Hospital NICU between 2016 and 2019 were included. The exposure of interest was cumulative CREs from birth until 34 weeks postmenstrual age. The primary outcome was sNDI, defined as global developmental delay (≥2 standard deviations below the mean on standardized tests in at least two developmental domains) or cerebral palsy with gross motor function classification system III-V. Secondary outcomes included Bayley III composite scores for language, motor, and cognition. Characteristics of infants with or without sNDI were compared using univariate and multivariate regression analyses. Correlations between cumulative CREs and Bayley III composite scores were assessed using Pearson correlation coefficients (r). Subgroup analyses were repeated for infants receiving mechanical ventilation (MV) < 7 days and for CREs in the first week only. Results 151 infants (mean GA 25.79, SD 1.24) were included, of which 44 (29%) had sNDI. Infants with sNDI had significantly more frequent severe intraventricular hemorrhage, more frequent postnatal infections, and longer MV exposure compared to infants without sNDI (Table 1). Weekly and cumulative CREs were higher in infants without sNDI, but only week 4 showed a significant difference (p = 0.002, Fig 1). After adjusting for confounders, only severe intraventricular hemorrhage and MV duration were independently associated with sNDI. Scatter plots of cumulative CREs and Bayley III composite scores did not show significant correlations (r = -0.061, 0.075, and 0.041) for language, motor, and cognitive scores, respectively. Subgroup analyses showed no further significant associations. Conclusion Although nurse-documented CREs commonly shape decision-making in extremely preterm infants, they are not associated with increased sNDI at 18-24 months corrected age. More precise and quantitative monitoring of CREs may be needed to better understand their association with clinically meaningful long-term outcomes.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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".