Frontiers in pediatrics · 2026
Predicting severe intraventricular hemorrhage in very preterm and/or very low birth weight infants: a nomogram approach.
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Meng Wenying, Li Yang, Sun Xiaowei, Wen Jialin, Yang Haiping
Аннотация
BACKGROUND: Severe intraventricular hemorrhage (IVH) is a major brain injury in very preterm and/or very low birth weight infants. We developed a simple model to distinguish severe IVH from mild IVH among very preterm and/or very low birth weight infants with IVH using routinely available perinatal factors.
METHODS: This retrospective multicenter study included infants born at <32 weeks' gestation and/or with birth weight < 1,500 g admitted to three tertiary neonatal intensive care units (NICUs) in northern China (January 2023-December 2024). IVH was assessed by cranial ultrasonography and graded by the modified Papile system; grades III-IV were defined as severe. Least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression were used to build a nomogram. Discrimination and calibration were evaluated, internal validation was performed using bootstrap resampling, and decision curve analysis was used as an exploratory assessment of clinical utility.
RESULTS: Among 161 infants with IVH, gestational age, base excess (BE), and meningitis-consistent cerebrospinal fluid (CSF) abnormalities were retained as predictors. The apparent C-index/AUC was 0.744 (95% CI: 0.653-0.834), and the optimism-corrected C-index/AUC after bootstrap internal validation was 0.727 (95% CI: 0.646-0.826). The Brier score was 0.171, and the optimism-corrected calibration slope was 0.934.
CONCLUSIONS: Among very preterm and/or very low birth weight infants with IVH, a nomogram based on gestational age, BE, and meningitis-consistent CSF abnormalities may help preliminary risk stratification and identify infants who may warrant closer cranial ultrasound surveillance and monitoring. External validation is required before broader clinical implementation.
METHODS: This retrospective multicenter study included infants born at <32 weeks' gestation and/or with birth weight < 1,500 g admitted to three tertiary neonatal intensive care units (NICUs) in northern China (January 2023-December 2024). IVH was assessed by cranial ultrasonography and graded by the modified Papile system; grades III-IV were defined as severe. Least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression were used to build a nomogram. Discrimination and calibration were evaluated, internal validation was performed using bootstrap resampling, and decision curve analysis was used as an exploratory assessment of clinical utility.
RESULTS: Among 161 infants with IVH, gestational age, base excess (BE), and meningitis-consistent cerebrospinal fluid (CSF) abnormalities were retained as predictors. The apparent C-index/AUC was 0.744 (95% CI: 0.653-0.834), and the optimism-corrected C-index/AUC after bootstrap internal validation was 0.727 (95% CI: 0.646-0.826). The Brier score was 0.171, and the optimism-corrected calibration slope was 0.934.
CONCLUSIONS: Among very preterm and/or very low birth weight infants with IVH, a nomogram based on gestational age, BE, and meningitis-consistent CSF abnormalities may help preliminary risk stratification and identify infants who may warrant closer cranial ultrasound surveillance and monitoring. External validation is required before broader clinical implementation.