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a Department of
Paediatrics, Derriford Hospital, Plymouth PL6 8DH
Email: harry.baumer{at}phnt.swest.nhs.uk, b Department of Statistics,
Plymouth University, Drake Circus,
Plymouth
Correspondence to: Dr H Baumer.
Accepted 1 May 1997
AIM
To determine the perinatal factors associated
with initial illness severity (measured by the CRIB (clinical risk
index for babies) score) and its relation to survival to discharge.
METHODSA retrospective study was made of
intensive care nursing records on 380 inborn babies, of less than 31 weeks gestation or 1501 g birthweight, admitted to one unit between
1984-6 and 1991-4.
RESULTSBetween the two time periods mean initial
illness severity score increased significantly from 2.8 to 3.9. This
was the result of an increase in the maximum appropriate inspired
oxygen concentration in the first 12 hours. Risk adjusted survival did
not improve over time after accounting for gestation but was
significantly greater after accounting for CRIB score. Illness severity
score was also significantly inversely associated with gestation and 1 and 5 minute Apgar scores, using multiple regression analysis. Between
the two time periods there was also a 92% increase in the admission
rate of babies under 31 weeks gestation, higher median 1 and 5 minute
Apgar scores (6 vs 5 and 9 vs 8, respectively), more multiple births, and more caesarean section deliveries.
CONCLUSIONSThe increase in illness severity score
and admission rate may reflect changes in obstetric practice. The
increase in illness severity score may also reflect changes in early
neonatal care. However, after adjusting for CRIB score, risk adjusted
mortality fell significantly, suggesting that neonatal care 12 hours
from birth onwards had improved with time.
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 L Gagliardi, A Cavazza, A Brunelli, M Battaglioli, D Merazzi, F Tandoi, D Cella, G F Perotti, M Pelti, I Stucchi, et al. Assessing mortality risk in very low birthweight infants: a comparison of CRIB, CRIB-II, and SNAPPE-II Arch. Dis. Child. Fetal Neonatal Ed., September 1, 2004; 89(5): F419 - F422. [Abstract] [Full Text] [PDF]
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International Neonatal Network, S. N. Consultants, and N. C. S. Group Risk adjusted and population based studies of the outcome for high risk infants in Scotland and Australia Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2000; 82(2): 118F - 123. [Abstract] [Full Text]
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