Early prediction of poor outcome in extremely low birth weight infants by classification tree analysis

J Pediatr. 2006 Apr;148(4):438-444. doi: 10.1016/j.jpeds.2005.11.042.


Objective: To predict death or neurodevelopmental impairment (NDI) in extremely low birth weight infants by classification trees with recursive partitioning and automatic selection of optimal cut points of variables.

Study design: Data from the Trial of Indomethacin Prophylaxis in Preterms were randomly divided into development (n=784) and validation sets (n=262). Three models were developed for the combined outcome of death (8 days to 18 months) or NDI (cerebral palsy, cognitive delay, deafness, or blindness at 18 months corrected age): antenatal: antenatal data; early neonatal: antenatal+first 3 days data; and first week: antenatal, first 3 days, and 4th to 8th days data. Decision trees were tested on the validation set.

Results: Variables associated with death/NDI in each model were: Antenatal: Gestation<or=25.5 weeks and antenatal steroids<7 days. Early neonatal: Birth weight<or=787 g and fluid intake>01 mL/kg/d. First week: Birth weight<or=787 g: transfusion>3 mL/kg/d. Birth weight>787 g: cranial echodense intraparenchymal lesion and transfusion>1 mL/kg/d. Correct classification rates were 61% to 62% for all models.

Conclusions: The ability to predict long-term morbidity/death in extremely low birth weight infants does not improve significantly over the first week of life. Effects of different variables depend on age.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decision Trees*
  • Developmental Disabilities / epidemiology
  • Developmental Disabilities / prevention & control
  • Female
  • Fetal Viability*
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Infant, Premature*
  • Infant, Premature, Diseases / epidemiology
  • Infant, Premature, Diseases / mortality
  • Infant, Premature, Diseases / prevention & control
  • Infant, Very Low Birth Weight*
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Sensitivity and Specificity