Predicting progression from mild to severe intraventricular hemorrhage in preterm infants: predictor analysis and nomogram construction

This study aimed to screen predictors for progression from mild to severe intraventricular hemorrhage (IVH) and to construct a nomogram—a graphical tool that converts the values of multiple predictors into an individual risk probability—for individualized risk evaluation. This single-center retrospective cohort study enrolled 153 preterm infants with mild IVH (Papile grade I–II), categorized into stable mild ( n = 104) and progression ( n = 49) groups. Independent predictors were identified by multivariable logistic regression, and a nomogram was constructed. Model discrimination was assessed by receiver operating characteristic (ROC) analysis with bootstrap internal validation. Of 153 infants, 49 (32.0%) progressed to severe IVH. Six independent predictors were identified: chorioamnionitis (odds ratio [OR] 6.10, 95% confidence interval [CI] 2.44–15.28, P = 0.0001), patent ductus arteriosus (OR 3.44, 95% CI 1.26–9.36, P = 0.016), and initial grade II IVH (OR 3.54, 95% CI 1.19–10.57, P = 0.023) were associated with an increased risk of progression, whereas higher 1-minute Apgar score (OR 0.70, 95% CI 0.55–0.88, P = 0.002), higher absolute lymphocyte count (OR 0.53, 95% CI 0.35–0.80, P = 0.003), and preeclampsia (OR 0.26, 95% CI 0.08–0.83, P = 0.022) were associated with a decreased risk. The nomogram achieved an area under the curve (AUC) of 0.884 (95% CI 0.825–0.933); bootstrap validation yielded an optimism of 0.024 and a corrected AUC of 0.861. This nomogram may serve as an exploratory risk-stratification tool for assessing progression risk from mild to severe IVH in preterm infants. Chorioamnionitis, patent ductus arteriosus, higher initial IVH grade, low 1-minute Apgar score, and low absolute lymphocyte count increased risk, whereas preeclampsia decreased risk. The lower risk of progression observed in infants of mothers with preeclampsia may reflect the intensified prenatal surveillance associated with this condition. Infants with multiple risk factors may warrant intensified ultrasound surveillance. External validation is required before broader clinical application. not applicable.