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

ABSTRACT

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.