Baumer J H, Wright D, Mill T
Department of Paediatrics, Derriford Hospital, Plymouth.
Arch Dis Child Fetal Neonatal Ed. 1997 Nov;77(3):F211-5. doi: 10.1136/fn.77.3.f211.
To determine the perinatal factors associated with initial illness severity (measured by the CRIB (clinical risk index for babies) score) and its relation to survival to discharge.
A retrospective study was made of intensive care nursing records on 380 inborn babies, of less than 31 weeks gestation or 1501 g birthweight, admitted to one unit between 1984-6 and 1991-4.
Between the two time periods mean initial illness severity score increased significantly from 2.8 to 3.9. This was the result of an increase in the maximum appropriate inspired oxygen concentration in the first 12 hours. Risk adjusted survival did not improve over time after accounting for gestation but was significantly greater after accounting for CRIB score. Illness severity score was also significantly inversely associated with gestation and 1 and 5 minute Apgar scores, using multiple regression analysis. Between the two time periods there was also a 92% increase in the admission rate of babies under 31 weeks gestation, higher median 1 and 5 minute Apgar scores (6 vs 5 and 9 vs 8, respectively), more multiple births, and more caesarean section deliveries.
The increase in illness severity score and admission rate may reflect changes in obstetric practice. The increase in illness severity score may also reflect changes in early neonatal care. However, after adjusting for CRIB score, risk adjusted mortality fell significantly, suggesting that neonatal care 12 hours from birth onwards had improved with time.
确定与初始疾病严重程度（通过CRIB（婴儿临床风险指数）评分衡量）相关的围产期因素及其与出院存活率的关系。
对1984年6月至1991年4月期间收治于某一科室的380例胎龄小于31周或出生体重1501克的新生儿重症监护护理记录进行回顾性研究。
在这两个时间段之间，初始疾病严重程度平均评分从2.8显著增加至3.9。这是最初12小时内最大适宜吸入氧浓度增加的结果。在考虑胎龄后，风险调整后的存活率并未随时间改善，但在考虑CRIB评分后显著提高。使用多元回归分析，疾病严重程度评分也与胎龄、1分钟和5分钟阿氏评分显著负相关。在这两个时间段之间，胎龄小于31周的婴儿入院率也增加了9%，1分钟和5分钟阿氏评分中位数更高（分别为6分对5分和9分对8分），多胎分娩更多，剖宫产分娩更多。
疾病严重程度评分和入院率的增加可能反映了产科实践的变化。疾病严重程度评分的增加也可能反映了早期新生儿护理的变化。然而，在调整CRIB评分后，风险调整后的死亡率显著下降，这表明出生后12小时内的新生儿护理随时间有所改善。
