Re-evaluating the timing of sequential cranial ultrasound screening in very preterm infants for predicting neurodevelopmental outcomes

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Abstract
Objective Accurate and early prediction of neurodevelopmental impairment is a crucial endeavor in caring for very preterm infants (0–306 weeks) born between January 2004 and December 2018 with a neurodevelopmental assessment at 36 months corrected age were included. Three prediction models of neurodevelopmental impairment were compared: 1. A reference model including the gestational age, infant sex, and 2-week and 6-week ultrasound 2. A model including the gestational age, infant sex, and 6-week ultrasound 3. A model including the gestational age, infant sex, and 2-week ultrasound Results Of 786 eligible preterm infants born during the study period, 656/786 survivors were included in the analysis (mean gestational age 275 weeks, mean birth weight 1,133 g, and 55% male infants). At 36 months of corrected age, 30% developed neurodevelopmental impairment. All three models provided comparable discrimination areas under the curve (AUC) of neurodevelopmental impairment at 36 months of corrected age. Both the 6-week and the reference model had similar AUC of 0.68 (95% CI 0.63–0.72) and were not noticeably different from the 2-week model (AUC 0.66 (95% CI 0.61–0.70)). The 6-week model provided the best prediction with the lowest Akaike information criterion (AIC) of 766 for the 6-week-only model, AIC 769 for combined weeks 2 and 6 (reference model), and AIC 784 for the 2-week-only model. Conclusion In this cohort of very preterm infants, a model including 6-week ultrasound only was comparable to a reference model combining 2-week and 6-week ultrasound and showed nearly identical predictive performance of neurodevelopmental impairment at 36 months corrected age across a broad set of metrics; thus, it is redundant to do both the 2-week and 6-week ultrasound. Clinical relevance statement Late ultrasound at 6 weeks of age provided comparable diagnostic and prognostic information to a reference model combining 2-week and 6-week ultrasound and, if anything, was slightly superior to the 2-week ultrasound model, across a broad set of metrics. The 2-week ultrasound can be eliminated with no impact on the prediction of neurodevelopmental impairment at 36 months, promoting prudent resource allocation and stewardship in healthcare. Graphical Abstract
Funding Information
  • Phillips/RSNA seed grant 2021 (RSD2102, RSD2102)

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