Revista de Saúde Pública (Dec 1998)
Valor preditivo do "Clinical Risk Index for Babies" para o risco de mortalidade neonatal Predictive value of the "Clinical Risk Index for Babies" for the risk of neonatal death
Abstract
OBJETIVO: Comparar o valor preditivo do CRIB (Clinical Risk Index for Babies) para o risco de mortalidade neonatal ao peso de nascimento (PN) e idade gestacional (IG). MÉTODO: Numa coorte prospectiva foram estudados, durante o ano de 1996, 71 recém-nascidos admitidos na unidade de terapia intensiva, com PN 10 foi de 100%. CONCLUSÕES: O escore de CRIB > 10 correspondeu a maiores especificidade e valor preditivo positivo em relação aos demais parâmetros. A área determinada pela "receiver operating characteristic" relativa ao CRIB também foi superior. O CRIB mostrou-se um marcador mais acurado na previsão de risco de mortalidade quando comparado ao PN ou IG isoladamente.OBJECTIVE: Several indicators, mainly birthweight and gestational age, have been used to predict the mortality risk in neonatal intensive care units. In order to assess the potential value of CRIB in predicting neonatal mortality, the score was used over the first 12 hours of life of the newborns admitted to this unit, during the year of 1996. METHOD: The inclusion criteria consisted of all infants without inevitably lethal congenital malformations, birthweight below 1,500g and/or gestational age less than 31 weeks. Newborn children who died within 12 hours after delivery were excluded. The CRIB score covers birth weight, gestational age, the presence of congenital malformations (not inevitably lethal ) and three indexes of physiological status during first 12 hours after birth - maximum and minimum appropriate fraction of inspired oxygen and maximum (most acidotic) base excess. RESULTS: In a prospective cohort, seventy one newborn children were studied. The birthweight (average) was 1,119 ± 275.6 g, gestational age 30 weeks 4/7 ±2 weeks 3/7; male (57%); Apgar 1° min. score <=3 ( 36.2%) and Apgar 5° min. score < 5 (5.8%). The mortality rate was 29.6% (gold standard). But mortality rate by birthweight less than 1,000 gr. or gestational age lower than 29 weeks was 60.0% and for the CRIB score above 10 was 100%. DISCUSSION: The specificity and predictive positive values for CRIB score above 10 were greater than any other two parameters. The area under the receiver operating characteristic (ROC) curve for predicting death was significantly greater for CRIB than for birthweight alone. It was concluded that the CRIB score is a better predictive indicator for mortality than are birthweight and gestational age.
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