Escore CRIB, peso ao nascer e idade gestacional na avaliação do risco de mortalidade neonatal

Abstract

ObjectiveTo 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. MethodsFrom January 1997 to December 2000, the CRIB score was prospectively applied to all newborn infants admitted to the N ICU of an university hospital, of Londrina, Brazil, with birthweight under 1,500 g and/or less than 31 weeks' gestational age. The exclusion criteria were: death before 12 hours of life, presence of lethal congenital malformations and newborns who had been referred from other hospitals. ResultsTwo 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%. ConclusionsIn 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.

Fatores de risco para óbito em unidade de terapia intensiva neonatal, utilizando a técnica de análise de sobrevida

“…(4) In this study, a significant association for very low birth weight -below 1,500 grams, was identified, 57%, in agreement with other studies showing that this group mortality is still very high in Brazil, specially in those below 750 grams (14) and far away from the rate in the best services, with about 10% mortality for very low weight infants. (15) For the Araujo et al (16) study, low birth weight is associated with unfavorable social-economic situation, making the newborn more vulnerable to conditions such as prematurity.…”

“…(14) It was thus possible to identify risk factor associated with death in newborns staying in the Taubaté University Hospital neonatal ICU in the years 2005, 2006 and 2007, being these results comparable to others in literature reported populations. In addition, this model allowed hierarchically understanding the relationship between these factors in the causality of infant mortality, using a still seldom used study frame.…”

“…Although the variable gestational age was out the hierarchical model, it is important to take into consideration its influence in the newborn initial clinical status, as it is known that the organs and systems maturation physiological response changes each single gestation week. (14) According to Shrimpton (17) , a mean 100 grams birth weight increase in a low birth weight newborn is associated with 30% to 50% neonatal mortality It is still worthy emphasizing that neonatal mortality studies have found that the lower the fifth minute of life Apgar score, the lesser is the survival chance. (15) However, it is known that it is possible to see an Apgar score close to six in newborns from high risk pregnancies, cesarean sections or complicated births, being healthy premature babies, with a lower than in a full term baby muscle tonus.…”

The neonatal intubation causes defects in primary teeth of premature infants

“…Prematurity is immediate or late manifestations of the growth and development of children [1][2][3] , and the survival of premature infants one of the most important challenges of neonatology 4,5 . New technologies used in the neonatal intensive care led to improvements in the quality of perinatal care of preterm infants resulting in increased survival of newborns with morbidities such as perinatal asphyxia, respiratory distress syndrome (RDS), hemorrhage periintraventricular (HPIV) infections and necrotizing enterocolitis 6 .…”

Aspiração orotraqueal em bebês: implicações nos parâmetros fisiológicos e intervenções de enfermagem

“…(12) . Porém, vários estudos revelam haver um aumento nas taxas de morbimortalidade e atrasos no desenvolvimento neurocomportamental em RNs prematuros e com baixos pesos ao nascer, sendo essa relação inversamente proporcional, ou seja, quanto menores a idade gestacional e o peso ao nascer maiores são as complicações (11)(12)(13) . Outro aspecto relevante sobre a condição do RN ao nascer é escore obtido pelos bebês no Boletim de Apgar.…”