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The Neonatal Neurobiologic Risk Score: does it predict outcome in very premature infants?

C P Contractor1, G I Leslie, J R Bowen

  • 1Department of Neonatology, Royal North Shore Hospital, St. Leonards, N.S.W., Australia.

Indian Pediatrics
|February 1, 1996
PubMed
Summary

The Neonatal Neurobiologic Risk Score (NBRS) effectively predicts neurodevelopmental outcomes in very premature infants. A modified NBRS using key risk factors shows high accuracy in identifying infants with abnormal development.

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Area of Science:

  • Neonatalogy
  • Neurodevelopmental Pediatrics
  • Perinatal Medicine

Background:

  • Very premature infants (< 28 weeks gestation) face significant risks for adverse neurodevelopmental outcomes.
  • Accurate prediction of these outcomes is crucial for timely intervention and improved long-term health.
  • The Neonatal Neurobiologic Risk Score (NBRS) is a tool developed to assess these risks.

Purpose of the Study:

  • To validate the Neonatal Neurobiologic Risk Score (NBRS) for predicting neurodevelopmental outcomes up to 3 years of age in infants born before 28 weeks gestation.
  • To identify specific NBRS components that are most predictive of abnormal neurodevelopmental outcomes.

Main Methods:

  • A retrospective determination of the NBRS was performed for 56 infants born at < 28 weeks gestation.

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  • These infants were prospectively followed until 3 years of age, with neurodevelopmental assessments conducted at that time.
  • The NBRS scores were correlated with the 3-year neurodevelopmental outcomes, and the predictive value of individual NBRS items was analyzed.

    • Main Results:

    • A high NBRS at discharge was significantly associated with an increased risk of abnormal 3-year neurodevelopmental outcome (odds ratio 2.56, p = 0.002).
    • A modified NBRS, utilizing only significant predictors (acidosis, hypoxemia, hypotension, intraventricular hemorrhage, infection, hypoglycemia), demonstrated excellent predictive performance: sensitivity 1.00, specificity 0.98, positive predictive value 0.92, and negative predictive value 1.00.
    • The mean gestational age was 26 weeks, and 21% of infants had abnormal 3-year outcomes.

    Conclusions:

    • The Neonatal Neurobiologic Risk Score (NBRS) is a valid, simple, and objective tool for identifying very premature infants at high risk for abnormal neurodevelopmental outcomes.
    • The study successfully identified specific clinical events that contribute to poor neurodevelopmental outcomes in this vulnerable population.