A Clinical Prediction Rule for Histological Chorioamnionitis in Preterm Newborns

JV Been, SF Vanterpool, Jasmijn de Rooij -, Ingrid Rours, R.F. Kornelisse, MCJM Dongen, CJAW van Gool, Ronald de Krijger, P Andriessen, LJI Zimmermann, BW Kramer

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Abstract

Background: Histological chorioamnionitis (HC) is an intrauterine inflammatory process highly associated with preterm birth and adverse neonatal outcome. HC is often clinically silent and diagnosed postnatally by placental histology. Earlier identification could facilitate treatment individualisation to improve outcome in preterm newborns. Aim: Develop a clinical prediction rule at birth for HC and HC with fetal involvement (HCF) in preterm newborns. Methods: Clinical data and placental pathology were obtained from singleton preterm newborns (gestational age <= 32.0 weeks) born at Erasmus UMC Rotterdam from 2001 to 2003 (derivation cohort; n = 216) or Maxima MC Veldhoven from 2009 to 2010 (validation cohort; n = 206). HC and HCF prediction rules were developed with preference for high sensitivity using clinical variables available at birth. Results: HC and HCF were present in 39% and 24% in the derivation cohort and in 44% and 22% in the validation cohort, respectively. HC was predicted with 87% accuracy, yielding an area under ROC curve of 0.95 (95% CI = 0.92-0.98), a positive predictive value of 80% (95% CI = 74-84%), and a negative predictive value of 93% (95% CI = 88-96%). Corresponding figures for HCF were: accuracy 83%, area under ROC curve 0.92 (95% CI = 0.88-0.96), positive predictive value 59% (95% CI = 52-62%), and negati Conclusion: Using a clinical prediction rule composed of clinical variables available at birth, HC and HCF could be predicted with good test characteristics in preterm newborns. Further studies should evaluate the clinical value of these rules to guide early treatment individualisation.
Original languageUndefined/Unknown
JournalPLoS One (print)
Volume7
Issue number10
DOIs
Publication statusPublished - 2012

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