Illness severity measured by CRIB score: a product of changes in perinatal care?

Area of Science:

• Neonatalogy
• Perinatal Medicine
• Intensive Care

Background:

• Initial illness severity in newborns is a critical determinant of survival.
• Understanding perinatal factors influencing severity is essential for improving neonatal outcomes.

Purpose of the Study:

• To investigate perinatal factors linked to initial illness severity, measured by the Clinical Risk Index for Babies (CRIB) score.
• To examine the relationship between CRIB score and survival to discharge.

Main Methods:

• Retrospective analysis of 380 intensive care nursing records for inborn infants (<31 weeks gestation or <1501g birthweight).
• Data collected from two distinct time periods (1984-6 and 1991-4) to assess changes over time.
• Multiple regression analysis used to identify associations between illness severity, gestation, and Apgar scores.

Main Results:

• Mean initial illness severity (CRIB score) significantly increased from 2.8 to 3.9 between the two periods.
• Increased CRIB scores were inversely associated with gestational age and Apgar scores.
• Risk-adjusted survival improved significantly when accounting for CRIB score, despite no improvement when accounting for gestation alone.

Conclusions:

• Increased admission rates and illness severity scores may reflect evolving obstetric and early neonatal care practices.
• Despite rising severity, risk-adjusted mortality decreased, indicating improved neonatal care beyond the initial 12 hours.
• The CRIB score is a significant predictor of survival in this neonatal intensive care unit population.