Anthropometric outcome of extremely low birth weight and very low birth weight newborn at 12 months of corrected age associated with prenatal risk factors

Background: Advancement of skill, technology and perinatal medicine has led to improve survival of low birth weight babies during the last few decades but they have reported high incidence of growth failure during infancy and early childhood. The objective of the study was to find out the influence of perinatal risk factors on anthropometric outcome.Methods: A prospective cohort study conducted on 143 ELBW and VLBW babies admitted in Sick Newborn Care Unit (SNCU and PICU) of North Bengal Medical College and Hospital (NBMC), Darjeeling, West Bengal from 2016 to 2017 and discharged babies were followed up.Results: Total 143 neonates were studied at NBMC among male 82(57.3%) and female 61(42.7%), 95 were AGA and 48 were SGA babies. Significant positive correlations were found among birth weight, gestational age, perinatal infection (p<0.001). The mean weight for age (Mean'SD) was 7.615'1.1092 kg with median 7.8 kg. The mean length for age (Mean'SD) was 72.6'3.74 cm with median 73 cm. The mean head circumference for age (Mean'SD) was 42.5'2.12 cm median 43 cm. Adverse neonatal outcome associated with CRIB II score ?10. Total CRIB II score with parameters of growth (<-2 Z score) like weight for age, length for age, weight for length and head circumference for age shows significant correlation (p<0.001).Conclusions: Perinatal risk factors are important determinant for future anthropometric outcome in very low and extremely low birth weight babies. They should be identified, and appropriate measures should be taken to achieve good outcome.

Comparación de escalas de predicción mortalidad neonatal (crib, crib ii, snap ii, snappe ii) entre recién nacidos prematuros y a término / Comparison of neonatal mortality prediction scales (crib, crib ii, snap ii, snappe ii) between preterm and full term infants

Objetivo: Este artículo compara 4 escalas de predicción de mortalidad y gravedad de la enfermedad (CRIB, CRIB II, SNAPPE, SNAPPE II) en recién nacidos prematuros y a términos, ingresados a las unidades de cuidaos intensivos neonatales (UCIN) para determinar cuál de ellas, tiene mayor discriminación pronostica. Métodos: es un estudio transversal, observacional, multicéntrico para comparar varias escalas de predicción de mortalidad y de la enfermedad. Se recolectaron datos de 227 recién nacidos ingresados a las UCIN de 4 hospitales desde julio a diciembre del 2018. Evaluamos las escalas CRIB, CRIB II, SNAPII y SNAP-PE score en recién nacidos prematuros y a término. El área bajo la curva (ROC) fue usada para evaluar y comparar los resultados de predicción de mortalidad y morbilidad. Resultados: Un total of 227 recién nacidos fueron evaluados (media CRIB: 7,81±3,52 media CRIB-II: 11,96±3,91; media SNAP-II: 34,99±16,83, SNAPPE II: 14,61±13,30). Se evidenció una mayor discriminación para las escalas CRIB II y CRIB en relación con SNAP-II y SNAPP II (AUC 0.94 y 0.93 vs 0.86 y 0,77). Además de cada puntuación, varias variables influyeron significativamente en la supervivencia en los modelos de regresión logística. Conclusiones: Todas las escalas de predicción de mortalidad y de gravedad de la enfermedad sirven para utilizarse en las UCIN estudiadas, siendo la escala CRIB II la de mejor rendimiento para aplicarse en nuestro medio.

Objective: This article compares 4 scales of prediction of mortality and disease severity (CRIB, CRIB II, SNAPPE, SNAPPE II) in preterm and term new borns admitted to neonatal intensive care units (NICU) to determine which of them has greater forecast discrimination. Methods: it is a cross-sectional, observational, multicenter study that compares several mortality and disease prediction scales. Data were collected from 227 newborns admitted to the NICU of 4 hospitals from July to December 2018. We evaluated the CRIB, CRIB II, SNAPII and SNAP-PE score scales in preterm and full term infants. The area under the curve (ROC) was used to evaluate and compare the prediction results of mortality and morbidity. Results: A total of 227 newborns were evaluated (mean CRIB: 7.81 ± 3.52 mean CRIB-II: 11.96 ± 3.91, average SNAP-II: 34.99 ± 16.83, SNAPPE II: 14.61 ± 13.30). There was evidence of greater discrimination for the CRIB II and CRIB scales in relation to SNAP-II and SNAPP II (AUC 0.94 and 0.93 vs 0.86 and 0.77). In addition to each score, several variables significantly influenced survival in the logistic regression models. Conclusions: All the prediction scales of mortality and severity of the disease serve to be used in the studied NICUs, being the CRIB II scale the best performance to apply in our environment.

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.

Comparison of Outcomes According to the Hospitals of Antenatal Care in Very Low Birth Weight Infants

PURPOSE: The purpose of this study was to evaluate the differences according to the hospitals of antenatal care in premature infants. METHODS: We retrospectively reviewed the medical records of premature infants with gestational ages <37 weeks and very low birth weights who were admitted immediately after birth to the neonatal intensive care unit (NICU) at the Dongguk University Ilsan Hospital between March 2007 and February 2009. The hospitals of antenatal care were divided into two levels (primary antenatal care hospital: hospitals with less than a level 2 NICU, secondary antenatal care hospital: hospitals with a level 3 NICU) based on the level of NICU in hospitals. In addition, total infants were divided into two groups (Immediate group: infants born within 24 hours of maternal admission, Delayed group: infants born after 24 hours of maternal admission). The differences between maternal and neonatal variables in each groups were studied. RESULTS: Neonates in secondary antenatal care hospitals comprised 11.0% of the study neonates (10 of 91). We compared with two groups (primary antenatal care hospital and secondary antenatal care hospital), but there were no differences in all subjects. However, the 1 minute Apgar score (< or =3) was lower in the immediate group than the delayed group. CONCLUSION: Shorter duration of maternal admission to delivery was associated with a lower 1 minute Apgar score of neonates. These findings suggest that if maintenance of pregnancy is difficult when high-risk gravidas are transferred, clinicians must prepare for emergencies of neonates.

Recent outcome of extremely low birth weight infants: The use of CRIB(clinical risk index for babies) II score for analyzing the survival rate / 소아과

PURPOSE: The survival rate of infants weighing less than 1,000 g at birth(extremely low birth weight infants, ELBWI) has increased due to recent advances in perinatal and neonatal intensive care. The purpose of this study was to evaluate the survival rates of ELBWI born at Seoul National University Hospital during the last six years. METHODS: A total of 99 infants were divided into three groups(period I : 2000 to 2001, period II: 2002 to 2003, period III: 2004 to 2005) based on date of birth. We compared the survival rate of ELBWI over the three periods, using CRIB II score for adjustment for clinical severity. RESULTS: Overall survival rate of ELBWI was 74.7 percent. The survival rate of ELBWI increased over the three periods(period I: 60.7 percent, period II : 73.3 percent, period III: 85.3 percent). The threshold of viability(defined as survival of at least 50 percent of infants) was 25 weeks of gestation and 600 g at birth. The birth weight-specific survival rates increased considerably over the three periods for infants < 750 g at birth(period I: 10 percent, period II: 46.2 percent, period III: 70.6 percent). The survival rates of ELBWI over the three periods increased much remarkably after adjustment for clinical severity by CRIB II score. CONCLUSION: In our institution, survival rates of ELBWI during the last six years continued to improve, particularly for infants weighing < 750 g at birth. This increase in survival rates was not associated with the clinical severity of ELBWI.