[Using the CRIB as an early prognostic index for very low birthweight infants, treated in neonatal intensive care unites]

L Vakrilova, Z Emilova, B Slŭncheva, M Kalaĭdzhieva, T Pramatarova, N Iarŭkova
Akusherstvo i Ginekologii︠a︡ 2007, 46 Suppl 1: 66-73

UNLABELLED: The illness severity by admission in NICU reflects the intensity of the therapy, the prognosis for the newborn and the hospital costs. Using the CRIB (Clinical Risk Index for Babies) as an objective and easy method for measuring the illness severity in the first 12 h of life allows assessing the risk of death until discharge.

AIM: To apply the CRIB for assessing the illness severity and to investigate its prognostic value for life and risk of permanent disabilities among very low birthweight (VLBW) and gestational age (VLGA) infants.

METHODS: The study includes the inborn babies in the Specialized Obstetrics & Gynaecology Hospital "Maichin dom" with birthweight < 1500g and gestational age < 32 weeks of gestation, who are admitted in the NICU for 2 periods: I group--250 newborns in the period 01.2002-06.2004 and II group--186 newborns in the period 07.2004-06.2006. The CRIB is estimated based on data collected in the first 12 h of life. An analysis was made about the prognostic value of the CRIB score and the outcome. Criteria for outcome are: the in hospital mortality rate and disabilities such as severe intraventricular hemorrhages (IVH gr. III and IV), chronic lung disease (CLD) and retinopathy of prematurity (ROP).

RESULTS: We establish that the CRIB score is significantly higher among the infants who died--12.7%/13% in the I / II period compared with survivors--6.2% / 5.7% (P < 0.001). The mortality rates raise progressively with the CRIB score: among the newborns with CRIB 0-5 they are 2.9% / 2.6% and reaches up to 78.6% / 90% when the CRIB is > 15. The infants with permanent disabilities were with significantly higher CRIB scores too: 11.7 / 11.4% among the infants with IVH III-IV compared to 6.2 / 5.2 without; 9.6 / 10.1 among infants with CLD compared to 5.7 /5.2 without; 10.1 / 10 among infants with ROP compared to 5.5 / 5.1 without.

CONCLUSIONS: The CRIB score is useful and easy to apply early and objective prognostic criterion about the risk of in hospital death and permanent disabilities among VLBW newborns. It can be used as a basis for comparing the results of the different NICUs too.

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