[将CRIB作为极低出生体重儿在新生儿重症监护病房接受治疗的早期预后指标]

[Using the CRIB as an early prognostic index for very low birthweight infants, treated in neonatal intensive care unites].

作者信息

Vakrilova L, Emilova Z, Slŭncheva B, Kalaĭdzhieva M, Pramatarova T, Iarŭkova N

出版信息

Akush Ginekol (Sofiia). 2007;46 Suppl 1:66-73.

Abstract

UNLABELLED

The illness severity by admission in NICU reflects the intensity of the therapy, the prognosis for the newborn and the hospital costs. Using the CRIB (Clinical Risk Index for Babies) as an objective and easy method for measuring the illness severity in the first 12 h of life allows assessing the risk of death until discharge.

AIM

To apply the CRIB for assessing the illness severity and to investigate its prognostic value for life and risk of permanent disabilities among very low birthweight (VLBW) and gestational age (VLGA) infants.

METHODS

The study includes the inborn babies in the Specialized Obstetrics & Gynaecology Hospital "Maichin dom" with birthweight < 1500g and gestational age < 32 weeks of gestation, who are admitted in the NICU for 2 periods: I group--250 newborns in the period 01.2002-06.2004 and II group--186 newborns in the period 07.2004-06.2006. The CRIB is estimated based on data collected in the first 12 h of life. An analysis was made about the prognostic value of the CRIB score and the outcome. Criteria for outcome are: the in hospital mortality rate and disabilities such as severe intraventricular hemorrhages (IVH gr. III and IV), chronic lung disease (CLD) and retinopathy of prematurity (ROP).

RESULTS

We establish that the CRIB score is significantly higher among the infants who died--12.7%/13% in the I / II period compared with survivors--6.2% / 5.7% (P < 0.001). The mortality rates raise progressively with the CRIB score: among the newborns with CRIB 0-5 they are 2.9% / 2.6% and reaches up to 78.6% / 90% when the CRIB is > 15. The infants with permanent disabilities were with significantly higher CRIB scores too: 11.7 / 11.4% among the infants with IVH III-IV compared to 6.2 / 5.2 without; 9.6 / 10.1 among infants with CLD compared to 5.7 /5.2 without; 10.1 / 10 among infants with ROP compared to 5.5 / 5.1 without.

CONCLUSIONS

The CRIB score is useful and easy to apply early and objective prognostic criterion about the risk of in hospital death and permanent disabilities among VLBW newborns. It can be used as a basis for comparing the results of the different NICUs too.

摘要

未标注

新生儿重症监护病房（NICU）中入院时的疾病严重程度反映了治疗强度、新生儿预后及住院费用。使用CRIB（婴儿临床风险指数）作为一种客观且简便的方法来衡量出生后12小时内的疾病严重程度，有助于评估直至出院时的死亡风险。

目的

应用CRIB评估疾病严重程度，并研究其对极低出生体重（VLBW）和极早早产儿（VLGA）的生存预后及永久性残疾风险的预测价值。

方法

该研究纳入了“Maichin dom”专科医院妇产科出生体重<1500g且孕周<32周的足月儿，他们分两个阶段入住NICU：第一组——2002年1月至2004年6月期间的250名新生儿；第二组——2004年7月至2006年6月期间的186名新生儿。CRIB根据出生后12小时内收集的数据进行评估。对CRIB评分的预测价值及结局进行了分析。结局标准为：住院死亡率以及诸如重度脑室内出血（III级和IV级IVH）、慢性肺病（CLD）和早产儿视网膜病变（ROP）等残疾情况。

结果

我们发现，死亡婴儿的CRIB评分显著更高——第一/第二阶段分别为12.7%/13%，而存活婴儿为6.2%/5.7%（P<0.001）。死亡率随CRIB评分逐渐升高：CRIB评分为0 - 5的新生儿中死亡率为2.9%/2.6%，当CRIB>15时死亡率高达78.6%/90%。有永久性残疾的婴儿CRIB评分也显著更高：IVH III - IV级婴儿中为11.7/11.4%，无此类情况的婴儿为6.2/5.2%；CLD婴儿中为9.6/10.1%，无CLD的婴儿为5.7/5.2%；ROP婴儿中为10.1/10%，无ROP的婴儿为5.5/5.1%。