Validation of CRIB II for Prediction of Mortality in Premature Babies.

Objective: Validation of Clinical Risk Index for Babies (CRIB II) score in predicting the neonatal mortality in preterm neonates ≤32 weeks gestational age. Design: Prospective cohort study. Setting: Tertiary care neonatal unit. Subjects: 86 consecutively born preterm neonates with gestational age ≤32 weeks. Methods: The five variables related to CRIB II were recorded within the first hour of admission for data analysis. The receiver operating characteristics (ROC) curve was used to check the accuracy of the mortality prediction. H-L Goodness of fit test was used to see the discrepancy between observed and expected outcomes. Results: A total of 86 neonates (males 59.6%; mean birthweight: 1228± 398 grams; mean gestational age: 28.3 ± 2.4 weeks) were enrolled in the study, of which 17 (19.8%) left hospital against medical advice (LAMA) before reaching the study end point. Among 69 neonates completing the study, 24 (34.8%) had adverse outcome during hospital stay and 45 (65.2%) had favorable outcome. CRIB II correctly predicted adverse outcome in 90.3% (Hosmer–Lemeshow goodness-of-fit test P=0.6). Area under curve (AUC) for CRIB II was 0.9032. In intention to treat analysis with LAMA cases included as survivors, the mortality prediction was 87%. If these were included as having died then mortality prediction was 83.1%. Conclusion: The CRIB II score was found to be a good predictive instrument for mortality in preterm infants ≤32weeks gestation.

Calculating prevalence of hepatitis B in India: Using population weights to look for publication bias in conventional meta-analysis.

Publication bias can result from the propensity of researchers to document what is unusual. This can distort the inferences drawn in systematic reviews. To measure the distortion, it has been suggested that a second analysis be done; using weights proportional to the size of the population from which the samples are drawn. We re-evaluate data from a published meta-analysis on prevalence of hepatitis B in India, to see how this approach alters the results. Prevalence of hepatitis B among tribal and non-tribal populations in different States was analyzed. Weights were then assigned according to population of the State. The overall country prevalence was then calculated. Using population-weights it is estimated that the point-prevalence of hepatitis B among non-tribal populations is 3.07% [95% CI: 2.5 - 3.64]. Among tribal populations it is 11.85% (CI 10.76 -12.93). Overall prevalence was 3.70 (CI: 3.17 -4.24) (corresponding to a chronic carrier rate of 2.96%). The present analysis using population-weights has resulted in the estimated prevalence among non tribal populations increasing by 24% and that among tribal populations decreasing by 25.5% when compared to figures of the metaanalysis published earlier. The advantages and drawbacks of this procedure are discussed.