Brito Angela Sara J de, Matsuo Tiemi, Gonzalez Maria Rafaela C, de Carvalho Ana Berenice R, Ferrari Lígia S L
Departamento de Pediatria e Cirurgia Pediátrica, Universidade Estadual de Londrina, Londrina, PR, Brasil.
Rev Saude Publica. 2003 Oct;37(5):597-602. doi: 10.1590/s0034-89102003000500008. Epub 2003 Oct 9.
To evaluate the mortality rate of very low birth weight babies born at a Neonatal Intensive Care Unit (NICU) during a specified period of time according to variations in CRIB (Clinical Risk Index for Babies) score, birth weight and gestational age.
From January 1997 to December 2000, the CRIB score was prospectively applied to all newborn infants admitted to the NICU of an university hospital of Londrina, Brazil, with birthweight under 1,500 g and/or gestational age of less than 31 weeks. The exclusion criteria were: death before 12 hours of life, presence of lethal congenital malformations and newborns who had been referred from other hospital.
Two hundred and eighty-four infants met the inclusion criteria. Mean birth weight was 1,148 +/- 248 g (median=1,180), mean gestational age was 30.2 +/- 2.4 weeks (median=30.0) and mean CRIB score was 3.8 +/- 4.4 (median=2.0). The neonatal mortality rate was 23.2%, varying according to mean birthweight <750 g (72.7%), gestational age <29 weeks (57.1%) and CRIB score >10 (79.4%). Receiver Operating Characteristic (ROC) curves were composed for CRIB score, birth weight and gestational age to assess the ability of each to predict hospital mortality and the areas under the curve were respectively 0.88, 0.76 and 0.81. Sensitivity, specificity and predictive values were evaluated and all variables were considered predictors of mortality (p<0.0001). The optimal cut off point based on the ROC curve for the CRIB score was 4 with sensitivity 75.8%, specificity 86.7, positive predictive value 63.3% and negative predictive value 92.2%.
In this study infants with birthweight of less than 750 grams, less than 29 weeks gestational age and CRIB scores above 10 had higher mortality rates. However, a CRIB score higher than 4 proved to be a better predictor of mortality when compared to birthweight and gestational age.
根据婴儿临床风险指数（CRIB）评分、出生体重和胎龄的变化，评估特定时间段内在新生儿重症监护病房（NICU）出生的极低出生体重儿的死亡率。
1997年1月至2000年12月，对巴西隆德里纳一所大学医院NICU收治的所有出生体重低于1500g和/或胎龄小于31周的新生儿前瞻性应用CRIB评分。排除标准为：出生后12小时内死亡、存在致命性先天性畸形以及从其他医院转诊来的新生儿。
284例婴儿符合纳入标准。平均出生体重为1148±248g（中位数=1180），平均胎龄为30.2±2.4周（中位数=30.0），平均CRIB评分为3.8±4.4（中位数=2.0）。新生儿死亡率为23.2%，根据平均出生体重<750g（72.7%）、胎龄<29周（57.1%）和CRIB评分>10（79.4%）而有所不同。绘制了CRIB评分、出生体重和胎龄的受试者操作特征（ROC）曲线，以评估各自预测医院死亡率的能力，曲线下面积分别为0.88、0.76和0.81。评估了敏感性、特异性和预测值，所有变量均被视为死亡率的预测指标（p<0.0001）。基于CRIB评分的ROC曲线，最佳截断点为4，敏感性为75.8%，特异性为86.7%，阳性预测值为63.3%，阴性预测值为92.2%。
在本研究中，出生体重低于750克、胎龄小于29周且CRIB评分高于10的婴儿死亡率较高。然而，与出生体重和胎龄相比，CRIB评分高于4被证明是更好的死亡率预测指标。
