Fowlie P W, Tarnow-Mordi W O, Gould C R, Strang D
Department of Child Health, Ninewells Hospital and Medical School, Dundee.
Arch Dis Child Fetal Neonatal Ed. 1998 May;78(3):F175-8. doi: 10.1136/fn.78.3.f175.
To investigate the feasibility of developing an objective tool for predicting death and severe disability using routinely available data, including an objective measure of illness severity, in very low birthweight babies.
A cohort study of 297 premature babies surviving the first three days of life was made. Predictive variables considered included birthweight, gestation, 3 day cranial ultrasound appearances and 3 day CRIB (clinical risk index for babies) score. Models were developed using regression techniques and positive predictive values (PPV) and likelihood ratios (LR) were calculated.
On univariate analysis, birthweight, gestation, 3 day CRIB score and 3 day cranial ultrasound appearances were each associated with death. On multivariate analysis, 3 day CRIB score and 3 day cranial ultrasound appearances remained independently associated. A 3 day CRIB score > 4 along with intraventricular haemorrhage (IVH) grade 3 or 4 was associated with a PPV of 64% and an LR of 9.8 (95% confidence limits 3.5, 27.9). Only 3 day CRIB score and 3 day cranial ultrasound appearances were associated with severe disability on univariate analysis. Both remained independently associated on multivariate analysis. A 3 day CRIB score > 4 along with an IVH grade of 3 or 4 was associated with a PPV of 60% and an LR of 24.2 (95% CI 4.4, 133.3).
Incorporating objective measures of illness severity may improve current prediction of death and disability in premature infants.
研究利用常规可得数据，包括疾病严重程度的客观测量指标，开发一种用于预测极低出生体重儿死亡和严重残疾的客观工具的可行性。
对297名出生后存活头三天的早产儿进行了队列研究。考虑的预测变量包括出生体重、孕周、出生3天的头颅超声表现和出生3天的CRIB（婴儿临床风险指数）评分。使用回归技术建立模型，并计算阳性预测值（PPV）和似然比（LR）。
单因素分析中，出生体重、孕周、出生3天的CRIB评分和出生3天的头颅超声表现均与死亡相关。多因素分析中，出生3天的CRIB评分和出生3天的头颅超声表现仍独立相关。出生3天的CRIB评分>4且伴有3级或4级脑室内出血（IVH），其PPV为64%，LR为9.8（95%置信区间3.5, 27.9）。单因素分析中，只有出生3天的CRIB评分和出生3天的头颅超声表现与严重残疾相关。多因素分析中两者仍独立相关。出生3天的CRIB评分>4且伴有3级或4级IVH，其PPV为60%，LR为24.2（95%CI 4.4, 133.3）。
纳入疾病严重程度的客观测量指标可能会改善目前对早产儿死亡和残疾的预测。
