Evaluation of clinical risk factors ((Clinical Risk Index for babies in predicting survival of extremely low birth weight infants

Very low birth weight(VLBW) babies constitute approximately 4%-7% of all live births and the mortality in this subgroup is high, contributing to as much as 30% of early neonatal deaths. Some scoring system like the Clinical Risk Index for Babies(CRIB) Score and the Score for Neonatal Acute Physiology (SNAP), for assessing the risk of mortality frequently utilized in newborns. The predictive value of CRIB (Clinical Risk Index for babies) for the survival of very low birth weight neonates(VLBW) was determined. In this cross-sectional study from 2002 to 2008, the CRIB score was applied to all newborns (n=494) with a birth weight of <1,500 g and gestational age <37 weeks. Predictive value of CRIB (Clinical Risk Index for Babies) for mortality of neonates was determined and compared with that of gestational age and birth weight. Four hundred ninety four very low birth weight neonates were included in this study. From those, 261 were expired; giving a mortality rate of 52.5%. The mean CRIB was 14.52 ± 2.4 (range: 7-25).Mean CRIB of expired neonates was significantly higher than survivors (15.34 ± 2.6 vs. 13.5 ± 1.7; p<0.0001). In the Receiver Operator Characteristic (ROC) analysis, the optimal cutoff point for the CRIB score to identify neonates at the risk of mortality was 13 with 82% sensitivity, specificity of 50%, positive predictive value of 65% and negative predictive value of 72%. Sensitivity, specificity, positive and negative predictive values of gestational age under 31 weeks for predicting mortality were also 83%,63%,71% and 77%, respectively. In addition, sensitivity, specificity, positive and negative predictive values of birth weight for predicting mortality with the cutoff point of 1000 gr were 35%, 92%,84%, and 56%,respectively. CRIB score can be used for identifying neonates at risk of mortality and predicting the neonatal outcome. However, the predictive value of CRIB is not higher than birth weight or gestational age.