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Published on: August 25, 2014
Evaluating illness severity for very low birth weight infants: CRIB or CRIB-II?
Claudio De Felice1, Antonio Del Vecchio, Giuseppe Latini
1Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
Insights
The Clinical Risk Index for Babies (CRIB) and its updated version (CRIB-II) show similar accuracy in predicting mortality for very low birth weight infants. Neither score is superior to gestational age or birth weight alone in this prediction.
Area of Science:
- Neonatal Intensive Care Unit (NICU) research
- Pediatric critical care medicine
- Infant health risk assessment
Background:
- Accurate estimation of in-hospital mortality risk is crucial in the NICU.
- The Clinical Risk Index for Babies (CRIB) is a standard tool for assessing illness severity in premature infants.
- The CRIB score was recently updated and simplified to the five-item CRIB-II scoring system.
Purpose of the Study:
- To compare the predictive accuracy of the original CRIB score and the CRIB-II score for in-hospital mortality.
- To evaluate these scores in a tertiary NICU with a minimal intubation policy.
- To assess if CRIB or CRIB-II offer advantages over gestational age and birth weight in predicting mortality.
Main Methods:
- A cohort of 147 very low birth weight (VLBW) infants was studied.
- Both CRIB and CRIB-II scores were calculated for each infant.
- Receiver-operating characteristic (ROC) curve analysis, using the area under the curve (AUC), was employed to compare predictor accuracy for in-hospital mortality.
Main Results:
- The mean AUCs for predicting mortality in VLBW infants ranged from 0.924 for CRIB to 0.869 for gestational age.
- No statistically significant differences were found in AUCs between CRIB and CRIB-II.
- No significant differences were observed when comparing CRIB or CRIB-II against gestational age or birth weight.
Conclusions:
- CRIB and CRIB-II demonstrate comparable accuracy in predicting in-hospital mortality among VLBW infants.
- Neither CRIB nor CRIB-II provides a predictive advantage over simply using gestational age or birth weight.
- These findings suggest that therapeutic interventions may influence the predictive accuracy of these risk-scoring systems.
Background:
Estimating the risk of in-hospital mortality provides essential information in the neonatal intensive care unit (NICU). The clinical risk index for babies (CRIB) is a widely used, risk-adjustment instrument to determine illness severity in infants of gestational age
Methods:
A total of 147 very low birth weight (VLBW) infants were examined. Both CRIB and CRIB-II scores were calculated for each newborn, and death before hospital discharge was selected as the outcome measure. Comparisons were performed by receiver-operating characteristic (ROC) curve analysis, and the area under the curve (AUC) was used as a measure of predictor accuracy.
Results:
Mean AUCs for CRIB, CRIB-II, gestational age and birth weight in identifying neonatal mortality in VLBW infants ranged from 0.924 (CRIB) to 0.869 (gestational age). No significant differences were found for the AUCs of CRIB versus CRIB-II, CRIB versus gestational age, CRIB versus birth weight, CRIB-II versus gestational age, or CRIB-II versus birth weight.
Conclusions:
Our findings show that; 1) CRIB and CRIB-II show similar accuracy values in predicting in-hospital neonatal mortality in VLBW infants; and 2) neither score offers an advantage in predicting mortality, as compared to gestational age or birth weight, thus suggesting that treatment modalities may modify predictive accuracy.
