Clinical Risk Index for Babies score II (CRIB II score) is a five-items scoring system to predict initial risk of mortality among neonates less than 32 weeks of gestation. Thus, making it an easy, quick and economical tool for early detection of preterm neonates’ mortality risk in resource limited busy centres in India.
To validate the efficacy of Clinical Risk Index for Babies score II in predicting pre-discharge neonatal mortality in early preterm neonates needing intensive care in a high resource tertiary care centre providing referral services in central India.
In this prospective observational study, after taking informed consent of parents and ethical committee clearance, the CRIB-II scores, which include birthweight, gestational age, sex, body temperature, and base excess, were recorded within the first hour of admission for 140 neonates of gestational age ranging between 28–31 weeks and birth weight ranging from 1000 g to 2499 g; of both sexes born in a tertiary care institute of central India and admitted to its neonatal intensive care unit (NICU). Babies of gestation <28 weeks and >31 completed weeks, birth weight < 1000 g, having lethal congenital malformations, delivery room deaths and those admitted after 1 hr of birth were excluded. Outcome measure was in hospital death or discharge. The sensitivity and specificity of CRIB-II scores and its cut off point to predict mortality were examined using Receiver Operating Characteristic curves (ROC) with area under curve (AUC) indicating predictive accuracy. Its association with mortality was determined by Cox Regression Hazard analysis. Clinical parameters were compared between Non-survivors and survivors by performing independent t-test. A p< 0.05 was considered as statistically significant.
Male: female ratio was 0.92:1. The mean Gestational age was 30.27 ± 0.89 weeks, mean birth weight being 1599.75 ± 282.35 g. CRIB II score ranged from 1–19 with a mean of 13.16 ± 25.56 among non survivors and mean of 5.66 ± 2.24 among the survivors (p value = < 0.0001). The total mortality in the study was 47.1 % (66/140). There was a progressive increase in mortality with increasing CRIB II score (p=0.001) and increase in survival with increasing birth weight, gestational age, body temperature and hospital stay (p < 0.0001 for each variable). CRIB II score ≥9 cut off was found to be significantly associated with neonatal mortality with sensitivity, predictive value and specificity of 95.65% , 95.65% and 95.77 % respectively (p<0.001; 95%CI 0.98(0.96–1.00); hazard ratio = 1.38). The ROC curve for CRIB II score was suggestive of AUC of 0.9868 ie 98% predictive accuracy.
The present study shows that the CRIB II score is a useful and reliable tool to prioritize the interventions in NICUs and will help to reduce the neonatal mortality rate and improve preterm neonates’ survival in India if used appropriately in tertiary care centres.
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