Guzmán Cabañas J M, Párraga Quiles M J, del Prado N, Ruíz M D, García Del Río M, Benito Zaballo F, Fernández C, Figueras Aloy J
Hospital Universitario Reina Sofía, Córdoba, España.
An Pediatr (Barc). 2009 Aug;71(2):117-27. doi: 10.1016/j.anpedi.2009.04.007.
To evaluate the usefulness of the Clinical Risk Index for Babies (CRIB) in predicting hospital mortality and severe intraventricular hemorrhage (IVH) in very low birth weight infants stratified by weight groups, in the Spanish neonatal network SEN 1500.
A prospective cohort study was made. Morbidity-mortality data and CRIB were collected in newborns weighing below 1500 g and admitted to 68 neonatal intensive care units between January 2002 and December 2006. Data were analyzed globally and stratified by weight groups (< 501 g, 500-750 g, 751-1000 g, 1001-1250 g, 1251-1500 g). Multivariate models were generated and ROC curves were plotted for estimating predictive values.
A total of 10,608 patients were analyzed. The mean weight was 1116 g (SD 267), and gestational age 29.5 weeks (SD 2.9). Low birth weight for gestational age was 34.3% and the multiple birth rate 36%. Prenatal corticoids were given in 78.2%. Severe intraventricular hemorrhage was diagnosed in 8.5%. Gender, prenatal corticoids, birth weight, gestational age and CRIB proved significant for the outcomes. CRIB showed the highest predictive accuracy in all strata (P < 0.001) except in the 501-750 g group, where it was similar to gestational age. Body weight showed the lowest AUC in all groups, except in the 1251-1500 g group, where it was no different to gestational age. Gestational age and CRIB yielded greater AUC values than weight (P < 0.001) in all groups. No significant differences were found between CRIB and gestational age, except in the 751-1000 g group, where gestational age was greater (P = 0.029).
The CRIB is the best predictor among newborns below 1500 g, except in the 501-750 g group, where CRIB is similar to gestational age. Body weight is the worst predictor, except in the group 1251-1500 g, where it is similar to gestational age. The accuracies of CRIB and gestational age in the prediction of IVH are similar, and both superior to body weight. This similarity persists in all the groups, except in the 751-1000 g interval, where gestational age is a better predictor.
评估婴儿临床风险指数（CRIB）在预测西班牙新生儿网络SEN 1500中按体重分组的极低出生体重儿的医院死亡率和重度脑室内出血（IVH）方面的效用。
进行了一项前瞻性队列研究。收集了2002年1月至2006年12月期间体重低于1500 g且入住68个新生儿重症监护病房的新生儿的发病-死亡数据及CRIB。对数据进行整体分析，并按体重组（<501 g、500 - 750 g、751 - 1000 g、1001 - 1250 g、1251 - 1500 g）分层。生成多变量模型并绘制ROC曲线以估计预测值。
共分析了10608例患者。平均体重为1116 g（标准差267），胎龄为29.5周（标准差2.9）。小于胎龄儿为34.3%，多胎率为36%。78.2%的患者接受了产前皮质类固醇治疗。重度脑室内出血的诊断率为8.5%。性别、产前皮质类固醇、出生体重、胎龄和CRIB被证明对结局有显著影响。除了在501 - 750 g组中CRIB与胎龄相似外，CRIB在所有分层中显示出最高的预测准确性（P < 0.001）。在所有组中，体重的AUC最低，除了在1251 - 1500 g组中体重与胎龄无差异。在所有组中，胎龄和CRIB产生的AUC值均高于体重（P < 0.001）。除了在751 - 1000 g组中胎龄更高（P = 0.029）外，CRIB与胎龄之间未发现显著差异。
在体重低于1500 g的新生儿中，CRIB是最佳预测指标，但在501 - 750 g组中，CRIB与胎龄相似。体重是最差的预测指标，除了在1251 - 1500 g组中体重与胎龄相似。CRIB和胎龄在预测IVH方面的准确性相似，且均优于体重。这种相似性在所有组中均存在，除了在751 - 1000 g区间内，胎龄是更好的预测指标。
