Predicting outcome in very low birthweight infants using an objective measure of illness severity and cranial ultrasound scanning
Department of Child Health, Ninewells Hospital and
Medical School, Dundee, DD1 9SY
Correspondence to: Dr Peter Fowlie.
Accepted 28 October 1997
AIM
To investigate the feasibility of developing
an objective tool for predicting death and severe disability using
routinely available data, including an objective measure of illness
severity, in very low birthweight babies.
METHODA cohort study of 297 premature babies
surviving the first three days of life was made. Predictive variables
considered included birthweight, gestation, 3 day cranial ultrasound
appearances and 3 day CRIB (clinical risk index for babies) score.
Models were developed using regression techniques and positive
predictive values (PPV) and likelihood ratios (LR) were calculated.
RESULTSOn univariate analysis, birthweight,
gestation, 3 day CRIB score and 3 day cranial ultrasound appearances
were each associated with death. On multivariate analysis, 3 day CRIB
score and 3 day cranial ultrasound appearances remained independently
associated. A 3 day CRIB score > 4 along with intraventricular
haemorrhage (IVH) grade 3 or 4 was associated with a PPV of 64% and an
LR of 9.8 (95% confidence limits 3.5, 27.9). Only 3 day CRIB score and
3 day cranial ultrasound appearances were associated with severe
disability on univariate analysis. Both remained independently associated on multivariate analysis. A 3 day CRIB score > 4 along with
an IVH grade of 3 or 4 was associated with a PPV of 60% and an LR of
24.2 (95% CI 4.4, 133.3).
CONCLUSIONIncorporating objective measures of
illness severity may improve current prediction of death and disability
in premature infants.
© 1998 by Archives of Disease in Childhood
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