Supplementary file 1_Development and validation of a nomogram for predicting unplanned PICC removal in preterm infants with gestational age <32 weeks.docx

ObjectiveTo develop and validate a risk prediction model for unplanned removal (UR) of peripherally inserted central catheters (PICC) in preterm infants with gestational age (GA) < 32 Weeks.
MethodsThis retrospective study analyzed preterm infants with PICC admitted to a neonatal intensive care unit (NICU) (January 2018 to December 2024). Clinical and catheter-related variables were assessed. Multivariable logistic regression identified predictors of PICC-UR, with model performance evaluated by C-index, calibration, and decision curve analysis (internal validation via 1000 bootstraps).
ResultsWe identified five independent predictors for PICC-UR: insertion site (categorical), white blood cell count (WBC), platelet count (PLT), and fibrinogen (Fib) (all modeled as continuous linear terms), along with hypercholanemia (HCA). These predictors were integrated into a nomogram designed to estimate the individual risk of PICC-UR in preterm infants. The predictive model demonstrated a high accuracy with a C-index of 0.827 [95% confidence interval (CI): 0.740–0.915]. Internal validation confirmed excellent calibration and significant clinical utility based on decision curve analysis.
ConclusionsThis validated nomogram, incorporating insertion site, WBC, PLT, Fib and HCA, aids early identification of high-risk infants. It offers actionable insights for optimizing PICC fixation and biochemical monitoring, potentially reducing PICC-UR in NICU.