A stage-based dynamic model for predicting bronchopulmonary dysplasia in very preterm infants using longitudinal lung ultrasound: a retrospective cohort study
- 1Department of Ultrasound Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital, Guangzhou Medical University , ,
Abstract
Background
Bronchopulmonary dysplasia (BPD) remains a major complication in very preterm infants (VPIs), and static clinical models may not capture evolving neonatal lung injury. We assessed whether a stage-based model using serial lung ultrasound (LUS) could improve early BPD prediction.Methods
In this retrospective single-center cohort, VPIs born at <32 weeks' gestation between January 2021 and December 2022 underwent LUS on postnatal days 7, 14, 21, and 28. Early clinical variables were collected, and BPD was defined by the 2018 NICHD criteria at 36 weeks' postmenstrual age. Single-time-point models were compared with stage-based dynamic models incorporating prior predicted risk and later LUS data, using bootstrap out-of-bag validation.Results
Among 269 VPIs, 174 developed BPD. LUS scores were higher in infants who developed BPD at all assessed time points. The best-performing single-time-point model used day-14 LUS (AUC 0.853, 95% CI 0.811-0.892). The three-stage random forest model achieved the highest point-estimate discrimination (AUC 0.874, 95% CI 0.835-0.909). Compared with the best-performing single-time-point model, the three-stage strategy showed an improvement in AUC of +0.021 (95% CI +0.005-+0.038). Compared with the two-stage strategy, the incremental difference in AUC was +0.009 (95% CI +0.001 to +0.018), whereas extension to the four-stage strategy showed no clear additional improvement (ΔAUC 0.006, 95% CI-0.004 to +0.016). In the three-stage model, prior-stage predicted risk and day-21 LUS remained independently associated with BPD.Conclusions
Serial LUS-based risk updating provided incremental prognostic information beyond single-time-point assessment. The three-stage model incorporating information through postnatal day 21 achieved the highest point-estimate discrimination, whereas extension to day 28 provided no clear additional predictive gain.
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BibTeX
@article{yang2026stagebased,
title = {{A stage-based dynamic model for predicting bronchopulmonary dysplasia in very preterm infants using longitudinal lung ultrasound: a retrospective cohort study}},
author = {Huihui Yang and Xiongpeng He and Xijie Xu and Xingpei Li and Jianyi Liao and Yu He},
journal = {Frontiers in pediatrics},
year = {2026},
month = oct,
doi = {10.3389/fped.2026.1928918},
url = {https://europepmc.org/article/PMC/PMC13752193},
note = {CC BY},
}
RIS
TY - JOUR
TI - A stage-based dynamic model for predicting bronchopulmonary dysplasia in very preterm infants using longitudinal lung ultrasound: a retrospective cohort study
AU - Huihui Yang
AU - Xiongpeng He
AU - Xijie Xu
AU - Xingpei Li
AU - Jianyi Liao
AU - Yu He
PY - 2026
DA - 2026/10/28
JO - Frontiers in pediatrics
DO - 10.3389/fped.2026.1928918
UR - https://europepmc.org/article/PMC/PMC13752193
AB - Background Bronchopulmonary dysplasia (BPD) remains a major complication in very preterm infants (VPIs), and static clinical models may not capture evolving neonatal lung injury. We assessed whether a stage-based model using serial lung ultrasound (LUS) could improve early BPD prediction.Methods In this retrospective single-center cohort, VPIs born at <32 weeks' gestation between January 2021 and December 2022 underwent LUS on postnatal days 7, 14, 21, and 28. Early clinical variables were collected, and BPD was defined by the 2018 NICHD criteria at 36 weeks' postmenstrual age. Single-time-point models were compared with stage-based dynamic models incorporating prior predicted risk and later LUS data, using bootstrap out-of-bag validation.Results Among 269 VPIs, 174 developed BPD. LUS scores were higher in infants who developed BPD at all assessed time points. The best-performing single-time-point model used day-14 LUS (AUC 0.853, 95% CI 0.811-0.892). The three-stage random forest model achieved the highest point-estimate discrimination (AUC 0.874, 95% CI 0.835-0.909). Compared with the best-performing single-time-point model, the three-stage strategy showed an improvement in AUC of +0.021 (95% CI +0.005-+0.038). Compared with the two-stage strategy, the incremental difference in AUC was +0.009 (95% CI +0.001 to +0.018), whereas extension to the four-stage strategy showed no clear additional improvement (ΔAUC 0.006, 95% CI-0.004 to +0.016). In the three-stage model, prior-stage predicted risk and day-21 LUS remained independently associated with BPD.Conclusions Serial LUS-based risk updating provided incremental prognostic information beyond single-time-point assessment. The three-stage model incorporating information through postnatal day 21 achieved the highest point-estimate discrimination, whereas extension to day 28 provided no clear additional predictive gain.
SN - 2296-2360
ER -