Deep learning models for early and accurate diagnosis of ventilator-associated pneumonia in mechanically ventilated neonates

Background: Early and accurate confirmation of critically ill neonates with a suspected diagnosis of ventilator-associated pneumonia (VAP) can optimize the therapeutic strategy and avoid unnecessary use of empirical antibiotics. We aimed to examine whether deep learning (DL) methods can assist the diagnosis of VAP of intubated neonates in the neonatal intensive care unit (NICU). Methods: A total of 670 neonates with mechanical ventilation were prospectively observed in a tertiary-level NICU in Taiwan between October 2017 and March 2022, during which image data were collected. All neonates with clinically suspected VAP were enrolled, and various DL methods were used to test the prediction ability of VAP diagnosis. The accuracy, precision, sensitivity, specificity, F1-score, and area under curves (AUCs) of several DL methods were compared. Results: A total of 900 chest X-ray images derived from 670 neonates with VAP and/or bronchopulmonary dysplasia (BPD) were enrolled, including 399 images from patients with definite diagnosis of VAP based on the strict criteria and 501 images from neonates without VAP. Compared with conventional DNN models such as ResNet, VGG, DenseNet, the RegNetX80 achieved the best specificity of 0.8378, which facilitates a low false positive rate. For accurate diagnosis of neonatal VAP, a combinatorial model of ResNet50 and RegNetX80, created through ensemble learning, further enhanced the AUC to 0.8023 for neonates with VAP on mechanical ventilation. In addition, the consistent XAI results in the left-lower region of chest X-ray image provided informative feedback and increased confidence to AI-assisted doctors. Conclusions: Deep learning methods are applicable with good predictive accuracy using chest X-ray images to help diagnosis of VAP in the NICU, which can help clinicians make decisions regarding the choices of empiric antibiotics for critically ill neonates. Future prospective trials are warranted to document its clinical usefulness and benefits on reducing medical resources.