Clinical Risk Index for Babies (CRIB II) Scoring System in Prediction of Mortality in Premature Babies

Abstract

Background: Clinical Risk Index for Babies scoring system (CRIB II) score is a recently developed tool to predict initial risk of mortality amongst low birth weight babies, the utility of which is scarce in many developing countries.

Objective: To assess the efficiency of CRIB II score as a tool to predict the risk for neonatal mortality among the LBW babies admitted to neonatal intensive care unit (NICU) at a tertiary care facility Kasr El-Aini paediatric hospital, Cairo, Egypt.

Materials and methods: Prospective cohort study design where 113 neonates, admitted during the first 24 hours to the NICU of Kasr El-Aini Hospital, from November 2013 till May 2014 were included. On admission, history taking, neonatal examination, arterial blood gas analysis and variables of CRIB II score were done. Subjects were followed up from admission till discharge or death.

Results: Male to female ratio was 1.1:1. Gestational age ranged from 25-32 weeks, the birth weight ranged from 700-1500 gm with mean of 1134.5 (± 202). CRIB II score ranged from 1-19 with a mean of 9.9 (± 4.0). The total mortality in the included cohort was 34.5% (31/113). Significant positive correlations were found between gestational age, birth weight, temperature, excess base, CRIB II score and the occurrence of mortality and with progressive increase in mortality with increasing CRIB II score (p=0.001). CRIB II score ≥ 11, gestational age ≤ 28 and birth weight ≤ 1100 were all found to be significantly associated with neonatal mortality. Area under ROC curve for CRIB II, gestational age and birth weight were found to be (0.968, 0.900 and 0.834) respectively. CRIB II score with cutoff point of ≥ 11 was the most sensitive (94.9%) with the predictive value (74.0%) and specificity (82.4%) compared to birth weight and gestational age. CRIB II score showed good calibration to predict neonatal mortality as demonstrated with Hosmer-lemeshow goodness of fit test (p= 0.952).

Conclusion: CRIB II score is a valid tool of initial risk assessment in LBW, predicting outcome more accurately than birth weight or gestational age alone. It is easily applicable and should replace the traditional models as predictor of neonatal outcome.

Keywords: Illness severity scores; Low birth weight- accuracy; Neonate intensive care.

Figures

[Table/Fig-4]:

ROC curve for prediction of hospital neonatal mortality by CRIB II score, birth weight and gestational age

[Table/Fig-7]:

Neonatal Survival curve in relation to Time