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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The CRIB (Clinical Risk Index for Babies) score and neurodevelopmental impairment at one year corrected age in very
1Department of Neonatology, Charité-Virchow Hospital, Humboldt University, Berlin, Germany. christoph.buehrer@charite.de
Insights
The Clinical Risk Index for Babies (CRIB) score shows an association with neurodevelopmental impairment in very low birth weight (VLBW) infants. However, its predictive value is limited for clinical stratification or hospital comparisons.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Clinical Risk Assessment
Background:
- Very low birth weight (VLBW) infants are at high risk for adverse neurodevelopmental outcomes.
- Accurate prediction of neurodevelopmental impairment (NDI) is crucial for early intervention and resource allocation.
- The Clinical Risk Index for Babies (CRIB) is a commonly used scoring system for assessing neonatal risk.
Purpose of the Study:
- To evaluate the predictive ability of the CRIB score for long-term neurodevelopmental impairment in VLBW infants.
- To determine if CRIB scores can effectively stratify VLBW infants for clinical trials or hospital performance comparisons.
Main Methods:
- A single-center cohort study included 455 VLBW infants admitted between 1992 and 1997.
- CRIB scores were calculated using parameters such as birth weight, gestational age, and oxygen requirements.
- Neurodevelopmental assessment at 1 year corrected age was performed using the Griffiths scales of mental development.
Main Results:
- Major neurodevelopmental impairment was observed in 22% of the 352 infants assessed.
- CRIB scores and specific components (e.g., maximum fraction of inspired oxygen) were independently associated with NDI.
- The predictive performance of the CRIB score for NDI was comparable to birth weight alone.
Conclusions:
- High CRIB scores are associated with an increased risk of major neurodevelopmental impairment in VLBW infants.
- The CRIB score has limited utility for stratifying infants in randomized trials or for adjusting performance metrics between hospitals when NDI is the primary outcome.
Objective:
To assess the ability of the Clinical Risk Index for Babies (CRIB) to predict long-term neurodevelopmental impairment in very low birth weight (VLBW) infants.
Design:
Single-center cohort study.
Setting:
Tertiary neonatal care hospital and follow-up clinic.
Patients:
Four hundred fifty-five VLBW infants consecutively admitted from 1992 to 1997 inclusive.
Measurements And Results:
Calculations of CRIB scores from birth weight, gestational age, the presence of congenital malformations, worst base excess, maximum and minimum appropriate fraction of inspired oxygen (FIO2) during the first 12 h of life was possible in 430 infants. Three hundred eighty-six infants survived until discharge (89%) and 352 (91%) were examined at 1 year corrected age using the Griffiths scales of mental development. Major neurodevelopmental impairment (general quotient < 2 standard deviations below average) was observed in 76 infants (22%). CRIB scores and the individual CRIB components differed significantly between infants with and those without neurodevelopmental impairment. By logistic regression analysis, CRIB scores and minimum FIO2 were independent predictors of death, while CRIB and maximum FIO2 were independently associated with neurodevelopmental impairment. For combined poor outcome (death or impairment), CRIB, minimum and maximum FIO2 were independent predictors. In predicting major neurodevelopmental impairment, the area under the receiver operating characteristic curve for CRIB (0.703 +/- 0.035) did not differ significantly from that of birth weight (0.697 +/- 0.035) or any other CRIB component.
Conclusion:
While high CRIB scores are associated with major neurodevelopmental impairment, the CRIB score is of limited value for stratification in randomized trials or for adjustments in comparing performance between hospitals with neurodevelopmental impairment as the main outcome measure.
