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Research Article: Opportunities and Challenges of Prognostic Models for Extremely Preterm Infants

Date Published: 2023-10-21

Abstract:
Predicting the short- and long-term outcomes of extremely preterm infants remains a challenge. Multivariable prognostic models might be valuable tools for clinicians, parents, and policymakers for providing accurate outcome estimates. In this perspective, we discuss the opportunities and challenges of using prognostic models in extremely preterm infants at population and individual levels. At a population level, these models could support the development of guidelines for decisions about treatment limits and may support policy processes such as benchmarking and resource allocation. At an individual level, these models may enhance prenatal counselling conversations by considering multiple variables and improving transparency about expected outcomes. Furthermore, they may improve consistency in projections shared with parents. For the development of prognostic models, we discuss important considerations such as predictor and outcome measure selection, clinical impact assessment, and generalizability. Lastly, future recommendations for developing and using prognostic models are suggested. Importantly, the purpose of a prognostic model should be clearly defined, and integrating these models into prenatal counselling requires thoughtful consideration.

Introduction:
Extremely preterm birth, defined as a gestational age below 28 weeks [1], is one of the main causes of perinatal morbidity and mortality [2]. With advancements in perinatal care and medical technology, the survival rates of extremely preterm infants (EPIs) have significantly improved in recent decades [3]. Nonetheless, improved survival rates raise the concern about adverse long-term outcomes in the increasing number of surviving EPIs [4]. Extremely preterm birth is associated with a variety of serious…

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