Clinical Risk Index For Babies Score Research Articles

Prevalence and Risk Factors for Post-Discharge Feeding Problems in Children Born Extremely Preterm.

Preterm infants have a high risk of post-discharge feeding problems, but there is a lack of population-based studies in infants born extremely preterm and little is known about underlying mechanisms. The objectives were to assess the incidence of post-discharge feeding problems and underweight in a population-based cohort of infants born extremely preterm in Sweden (EXPRESS) and identify perinatal risk factors. Perinatal health data and prenatal/postnatal growth data was prospectively collected in the cohort. Data on clinical diagnoses related to feeding problems were obtained from the Swedish Patient Register and population prevalence data was also obtained. The main outcome was a composite of post-discharge feeding problem diagnosis and/or underweight at 2.5 years of age. In total, 66 children (19%) had post-discharge feeding problems diagnosed before 2 years and/or underweight at 2.5 years of age. The risk of feeding problems when compared to the general population was significantly higher, with an odds ratio (OR) of 193 (95% confidence interval (CI) 137.6-270.9). The strongest risk factors for feeding problems were the number of days on mechanical ventilation during the first 8 postnatal weeks, OR of 1.59 (CI 95% 1.29-1.98), and the Clinical Risk Index for Babies-score, OR of 1.14 (CI 95% 1.03-1.26). Post-discharge feeding problems and underweight are common in children born extremely preterm. The strongest perinatal risk factor for later feeding problems was early treatment with mechanical ventilation. Identifying infants at risk of post-discharge feeding problems might be useful for targeting of nutritional support.

Validity of Clinical Risk Index for Babies (CRIB) Score in Predicting the Neonatal Mortality

Objective: To determine the validity of Clinical Risk Index for Babies (CRIB) score in predicting the neonatal mortality in very preterm neonates. Methodology: The 145 patients enrolled in this study were registered from NICU of Children Hosp, Lahore, they were preterm neonates with gestational age of ≤ 32 weeks. We determined six parameters of CRIB score; gestational age, birth weight, any congenital malformation, minimum and maximum FiO2 requirementduring 1st 12 hours of life and maximum base excess during 1st 12 hours of life. All parameters were recorded and assigned an individual score base upon CRIB scoring chart. Total CRIB score was determined by adding individual score of each parameter. We reviewed thebabiesdaily in NICU till discharge or death. Results: Out of 145 patients, 52.4%(n=76)male and female were 47.59%(n=69). Congenital malformations were present in 6.21% (n=9), mortality in 36.55%(n=53). Mean gestational age was 29.90±1.70weeks, mean birth weight1147.52±190.21grams, mean maximum base excess during first 12h of life-8.04±3.92mmol/L, mean minimum appropriate FiO2 in first 12h34.38±13.02 %, mean maximum appropriate FiO2 in first 12h69.17±21.11 % and mean CRIB Score was 4.63±3.67. AUR curve was 0.816 and std. error was recorded as =0.039;p=0.000. Conclusion: Mortality in very preterm neonates can be accurately predicted by using CRIB score. Keywords: Very Preterm Babies, Neonatal Mortality, CRIB Score, Validity

Comparison Between Score for Neonatal Acute Physiology Perinatal Extension II and Clinical Risk Index for Babies in Prediction of Neonatal Mortality in Septic Preterm Cases Tanta University Hospital’s Neonatal Intensive Care Unit

Background: Preterm birth (< 37 weeks gestation) is a major cause of death and a significant cause of long-term loss of human potential amongst survivors all around the world.
 Aim: Compare between two neonatal mortality risk scores, Score for neonatal acute physiology perinatal extension (SNAP-PE II) and Clinical risk index for babies (CRIB), in predicting the neonatal mortality in septic preterm admitted to neonatal intensive care unit (NICU) of Tanta University Hospital (TUH) over a period of one year.
 Patients and Methods: This was a prospective cohort study carried out on 200 septic preterm newborns admitted to NICU of TUH over 1 year period. 89 cases representing (44.5 %) were female and 111 cases representing (55.5%) were male. All of them were admitted to NICU [within their first 48 hours of birth]. All septic preterm neonates will be followed up till their death or discharge. SNAP-PE II and CRIB scores applied to all the septic preterm neonates in this study during the first 12 hours after diagnosis of sepsis in NICU according to Modified Hematological scoring system (MHSS).
 Results: There was a weak positive correlation between MHSS score for neonatal infection and both of the SNAP II and CRIB scores.
 Conclusion: Both SNAP-PE II and CRIB scores have good sensitivity for predicting neonatal mortality which was slightly higher in SNAPPE II score. Neonatal Mortality rate was significantly correlated with high MHSS.

Evaluation of Clinical Risk Index for Babies to Predict Mortality and Morbidity in Neonates Admitted to Neonatal Intensive Care Unit

Background: Premature birth, low birth weight, and congenital malformations are the main causes of neonatal mortality. The current study aimed at evaluating the predictive index of mortality and short-term morbidity of premature neonates in a hospital in karaj, Iran Methods: The present cross sectional study was conducted on 145 neonates admitted to the neonatal intensive care unit of (NICU) at Bahonar Hospital in karaj, Iran from 2014 to 2017. Neonates were selected by available sampling method and data were collected using their records; the mortality rate was calculated using the CRIB (clinical risk index for babies) checklist. Data were analyzed statistically. Results: The current study results indicated the high efficiency of both CRIB and CRIBӀӀ variables in predicting neonatal mortality (P = 0.000). The mean CRIB and CRIBII scores were respectively 9.24 and 9.04 in infants died during the study. Discussion: The CRIB score had a higher value in predicting mortality compared to that of CRIBII. CRIB score had a significant correlation with retinopathy of prematurity (ROP) (P = 0.01) and respiratory distress syndrome (RDS) (P = 0.011), but no significant relationship was found between CRIBӀӀ and the studied complications. There was a significant correlation between CRIB and CRIBӀӀ scores >8, and neural tube defect (P = 0.000). The predictive value of the CRIB score for neural tube defect was higher than that of the CRIBII. Conclusion: The results of the current study showed that CRIB and CRIBII can be utilized to predict mortality and neural tube defect in preterm infants and CRIB score can be used to predict ROP and RDS.

Comparative study of clinical parameters in newborns with hypoxic ischemic encephalopathy and severity of MRI abnormalities

Background: Hypoxic Ischemic Encephalopathy (HIE) is a leading causes of developmental impairment among infants. Scores for Neonatal Acute Physiology Perinatal Extension (SNAPPE) and Clinical Risk Index for Babies (CRIB) scores are known to correlate with future developmental outcomes in sick newborns. NICHD score ≥ 2 is defined as moderate to severe brain injury. Objective: To address the hypothesis that SNAPPE and CRIB scores are significantly higher for newborns that have increased severity of injury as shown by MRI findings. Additionally, clinical parameters like CRP(C- reactive protein), blood glucose levels and oxygenation status could predict the severity of brain injury. Design/Methods: …

SURVIVAL UNTIL DISCHARGE OF VERY-LOW-BIRTH-WEIGHT INFANTS IN TWO CROATIAN PERINATAL CARE REGIONS: A RETROSPECTIVE COHORT STUDY OF TIME AND CAUSE OF DEATH.

SUMMARYWe investigated mortality, causes, timing and risk factors for death until hospital discharge in very-low-birth-weight (VLBW) infants born in two Croatian perinatal care regions. This retrospective study included 252 live born VLBW infants. The mortality rate until hospital discharge was 30.5% (77/252). VLBW infants who died had by 4 weeks lower gestational age (GA) than surviving infants (median GA, 25 vs. 29 weeks), lower birth weight (BW) (mean BW, 756.4 vs. 1126.4 g), lower 5-minute Apgar score (median 5 vs. 8) and were more often resuscitated at birth (41.6 vs. 19.4%; p<0.001 all). Infants who survived were more often small-for-gestational age (SGA) (28.0 vs. 15.6%; p=0.04) and more often received continuous-positive-airway-pressure (CPAP) in delivery room (13.1 vs. 2.6%; p=0.01). Multivariate logistic regression revealed that parameters influencing death until hospital discharge were 5-minute Apgar score (OR 0.780, 95% CI 0.648-0.939) and higher Clinical Risk Index for Babies (CRIB) score (OR 1.677, 95% CI 1.456-1.931). ROC analysis showed that CRIB score (AUC 0.927, sensitivity 92.2, specificity 81.1; p<0.001) was the strongest predictor of death until hospital discharge. In infants who died within 12 hours, death was most commonly attributed to immaturity and in those surviving >12 hours to necrotizing enterocolitis.

Comparison between Score for Neonatal Acute Physiology-Perinatal Extension II (SNAP-PE II) and Clinical Risk Index for Babies (CRIB) in Prediction of Neonatal Mortality in Neonatal Intensive Care Unit (NICU) of Tanta University Hospital

AbstractBackground: Survival of the newborns who are admitted to the NICUs do not depend exclusively on birth weight and gestational age, but also on other perinatal factors and phys-iological conditions of the individual infants, in particular severity of their disease. More than one decade ago, the score for the neonatal acute physiology (SNAP), later the SNAP-perinatal extension (SNAP-PE) scores and clinical risk index for babies (CRIB) scores were proposed to be used in assessing severity, with sufficient precision to allow their application for quality assessment.Aim of Study: Was to compare between two neonatal mortality risk scores, SNAP-PE II and CRIB, in predicting the neonatal mortality in NICU of Tanta University Hospital (TUH ) over a period of one year and to measure the incidence of neonatal deaths in NICU of TUH over a period of one year.Patients and Methods: This was a prospective cohort study which was carried out on 500 newborns admitted to NICU of TUH over 1 year period. (From February 2016 to February 2017). All neonates were followed-up in NICU till their death or discharge. Neonates who had one of the following criteria were excluded: Newborn who died or was discharged in less than 24 hours after admission to our NICU, Infants whose APGAR score was not known, those who were admitted for observational purposes and those with were inevitably lethal congenital malformations. SNAP-PE II and CRIB scores applied to all the neonates in this study during the first 12 hours after their admission to NICU.Results: Area under the curve of both scores was nearly similar, meaning accuracy of both of them in predicting neonatal mortality.Conclusion: Both SNAP-PE II and CRIB scores have good sensitivity for predicting neonatal mortality which was slightly higher in SNAP-PE II score.

Risk-adjusted mortality of VLBW infants in high-volume versus low-volume NICUs

ObjectiveTo examine whether the number of very low birthweight (VLBW) infants treated annually in neonatal intensive care units (NICUs) (hospital volume) has an effect on their in-hospital mortality under the...

Correlation between Perfusion Index and CRIB Score in Sick Neonates Admitted to a Tertiary Center.

The study was to determine the correlation of Perfusion Index (PI) and Clinical Risk Index for Babies (CRIB) score, in assessing the severity of illness in sick neonates. This was a cross-sectional study conducted at a tertiary care Neonatal Intensive Care Unit (NICU). All eligible neonates, both term and preterm, admitted to the high-dependency unit of the NICU were included, after parental consent. Relevant details of history and examination were collected with a structured proforma. Severity of illness was assessed using CRIB score within 12 h of admission. PI was recorded within 24 h of admission, and babies were examined for the presence or absence of shock and their outcome was documented. The correlation coefficient between PI and CRIB score was derived. A total of 200 eligible newborns were enrolled. The mean gestational age of the neonates was 34 weeks. The median [interquartile range (IQR)] CRIB score was 1.00 (0.00, 3.00), and PI was 1.400 (0.93, 2.30). The Spearman's rank correlation coefficient between PI and CRIB score was -0.41 with p value <0.05. The median PI of neonates with CRIB score ≤5, 6-10 and >10 was 1.50, 0.74, 0.67, respectively (p value <0.0001). The median (IQR) PI of babies with shock and without shock was 0.63 (0.43, 0.84) and 1.58 (1.19, 2.41), respectively, with p value <0.001. PI has a negative correlation with CRIB score and can be used to assess the severity of illness in sick neonates.

Outcome of very-low-birth-weight babies managed with nasal continuous positive airway pressure, with or without surfactant, in a high-care nursery

Background. Very-low-birth-weight (VLBW) infants who require nasal continuous positive airway pressure (NCPAP) are managed in neonatal intensive care units (NICUs) in developed countries, while in low-resource settings this is not always possible. The failure rate of NCPAP provided outside NICUs is not well known. Objectives. To determine the failure rate, assessed as the need for invasive medical ventilation (iMV) and mortality on NCPAP in VLBW infants managed in a high-care nursery (HCN) within the first 72 hours of life. Methods. Records of VLBW infants managed with NCPAP, at Chris Hani Baragwanath Hospital, were reviewed for infant characteristics, need for iMV and mortality on NCPAP. Clinical risk index for babies (CRIB) was calculated for each infant. Comparisons were made between those who needed iMV and those who did not, and between survivors and non-survivors on NCPAP. Results. A total of 325 VLBW infants were managed with NCPAP in the HCN. Mean (standard deviation) birth weight was 1 120 (184)g, 98.5% were of gestational age (GA) <34 weeks and 14.9% were small for GA (SGA). Thirteen percent died while on NCPAP and 33% of survivors required iMV – an overall failure rate of 43%. Factors associated with iMV were high CRIB score ( p <0.001), lower Apgar score ( p =0.013), lower PaO2 ( p =0.022) and high base deficit ( p =0.034). Those who died were more likely to have extremely low birth weight ( p <0.001), lower GA ( p <0.001), high CRIB score ( p <0.001) and base deficit ( p <0.001). On multivariate analysis, the predictors for need of iMV were low Apgar score ( p =0.033), SGA ( p =0.042) and CRIB score ( p =0.005), while that of mortality on NCPAP was birth weight. Conclusion. Although failure rate of NCPAP in VLBW infants managed in HCN is high, a significant proportion of VLBW infants benefit from this intervention.

Protocole donneur unique : pratiques transfusionnelles et facteurs de risque des transfusions multiples en réanimation néonatale

In France since 2002, the single-donor transfusion protocol, using four pediatric units from the same adult donor's packed red blood cells (PRBCs) in multiply transfused newborns, is recommended in preterm neonates to reduce the risks of infection and alloimmunization. This protocol is controversial, however, because it causes the transfusion of stored blood, which could have adverse consequences. Before the new recommendations of the French Haute Autorité de santé (National authority for health) in 2015, we conducted a national practice survey in 63neonatal intensive care units (NICU) and a retrospective study of the characteristics of 103children transfused within our unit, to better target beneficiaries. The practice survey showed that 30% of French NICUs no longer used the protocol in 2014, due to logistical or financial problems, or concerns about the transfusion of stored blood. The practices were heterogeneous. Few NICUs used a written protocol. In our NICU, the use of single-donor protocol involved the use of units stored for more than 20days in half of the cases beginning with the third unit used. Six-term newborns were mainly transfused once, which does not seem to warrant the single-donor transfusion protocol. The use of this protocol caused the loss of 50% of the manufactured units, which go unused. In multivariate analysis, two factors were predictive of multiple transfusion within our population of 95premature neonates undergoing transfusion: low-term and a high Clinical Risk Index for Babies (CRIB) score. The risk of multiple transfusions would be reduced by about 15% for each additional week of gestation and approximately 16% per point within the CRIB score. These variables integrated into a statistical model predict the risk of multiplying transfusions. According to the ROC curve, a calculated risk higher than 50% is the appropriate cut-off value to transfuse with the single-donor transfusion protocol. This would limit its indications, saving more than 130pediatric units of blood for 100transfused children. A prospective study in our department will allow internal validation of this test.

The contribution of maternal psychological functioning to infant length of stay in the Neonatal Intensive Care Unit.

ObjectiveAssess maternal psychological functioning within the Neonatal Intensive Care Unit (NICU) and its contribution to neonate length of stay (LOS) in the NICU.Study designMothers of infants admitted to the NICU (n=111) were assessed regarding postpartum depression, postpartum social support, postpartum NICU stress, and maternal anxiety at 2 weeks postpartum. Illness severity was assessed with the Clinical Risk Index for Babies (CRIB).ResultsPostpartum depression was not significantly correlated with LOS, but was significantly correlated with trait anxiety (r=0.620), which was significantly correlated with LOS (r=0.227). Among mothers with previous mental health history, substance abuse history and CRIB score were the best predictors of LOS. For mothers without a prior mental health issues, delivery type, stress associated with infant appearance, and CRIB scores were the best predictors of LOS. In this group, LOS was found to increase on average by 7.06 days per one unit increase in stress associated with infant appearance among mothers with the same delivery type and CRIB score.ConclusionSignificant correlations of trait anxiety, stress associated with infant appearance, and parental role with LOS support the tenet that postpartum psychological functioning can be associated with NICU LOS.

Intravenous paracetamol for PDA closure in the preterm: a single-center experience.

Increasing recent evidence favors paracetamol use for patent ductus arteriosus (PDA) closure in preterms. Our study aims were (1) to assess efficacy and safety of intravenous (i.v.) paracetamol for PDA closure in a 23-32-week preterm population, as "first-line" (when traditional ibuprofen treatment was contraindicated) or "rescue" treatment (after ibuprofen failed), and (2) to identify predictors of PDA closure. The cumulative efficacy of consecutive cycles of i.v. paracetamol on PDA closure was confirmed after both "first-line" and "rescue" treatment, the overall PDA closure rates being, respectively, 56.7 and 61.1% (p = 0.7624) after two cycles and 63.3 and 77.8% (p = 0.2959) after three cycles. No toxicity was apparent after either "first-line" or "rescue" i.v. paracetamol treatment. On multivariate analysis, gestational age (GA) emerged as an independent predictor of PDA closure in the "first-line" i.v. paracetamol treatment group, while clinical risk index for babies (CRIB) score (a patient risk index based on birth weight, GA at birth, sex, patient's temperature on admission, and maximum base excess in first 12h of life) was an independent predictor of PDA closure failure in the "rescue" group. I.V. paracetamol proved effective in our study population. Randomized control trials (RCTs) are warranted to further investigate the efficacy and safety of i.v. paracetamol for PDA closure in preterms. • Oral paracetamol has been judged as effective as oral ibuprofen for PDA closure in the preterm. • To date, only a handful of non-randomized studies exist to support the effectiveness of i.v. paracetamol in PDA closure. What is New: • Our observations confirm the clinical efficacy of i.v. paracetamol for PDA closure in a very low birth weight (VLBW)/extremely low birth weight (ELBW) preterm population. • Gestational age and CRIB score emerge as independent predictors of PDA closure.

Auditing Neonatal Intensive Care: Is PREM a Good Alternative to CRIB for Mortality Risk Adjustment in Premature Infants?

Background: Comparing outcomes at different neonatal intensive care units (NICUs) requires adjustment for intrinsic risk. The Clinical Risk Index for Babies (CRIB) is a widely used risk model, but it has been criticized for being affected by therapeutic decisions. The Prematurity Risk Evaluation Measure (PREM) is not supposed to be prone to treatment bias, but has not yet been validated. Objectives: We aimed to validate the PREM, compare its accuracy to that of the original and modified versions of the CRIB and CRIB-II, and examine the congruence of risk categorization. Methods: Very-low-birth-weight (VLBW) infants with a gestational age (GA) <33 weeks, who were admitted to NICUs in Baden-Württemberg from 2003 to 2008, were identified from the German neonatal quality assurance program. CRIB, CRIB-II and PREM scores were calculated and modified. Omitting variables that directly reflected therapeutic decisions [the applied fraction of inspired oxygen (FiO₂)] or that may have been prone to early-treatment bias (base excess and temperature), non-NICU-therapy-influenced scores were obtained. Score performance was assessed by the area under their ROC curve (AUC). Results: The CRIB showed the largest AUC (0.89), which dropped significantly (to 0.85) after omitting the FiO₂. The PREM birth condition model, PREM(bcm) (AUC 0.86), and the PREM birth model, PREM(bm) (AUC 0.82), also demonstrated good discrimination. PREM(bm) was superior to other non-therapy-affected scores and to GA, particularly in infants with <750 g birth weight. Congruence of risk categorization was low, especially among higher-risk cases. Conclusions: The CRIB score had the largest AUC, resulting from its inclusion of FiO₂. PREM(bm), as the most accurate score among those unaffected by early treatment, seems to be a good alternative for strict risk adjustment in NICU auditing. It could be useful to combine scores.

CRIB scores as a tool for assessing risk for the development of pulmonary hypertension in extremely preterm infants with bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) increases the risk for developing pulmonary hypertension (PH). However, the risk factors associated with BPD-associated PH remain unclear. Our primary aim was to determine perinatal risk factors associated with the development of PH in infants with BPD. We retrospectively reviewed medical records of 303 infants born at ≤ 28 weeks' gestation. Infants were categorized as having no, mild, moderate, or severe BPD. PH was diagnosed by echocardiogram. Data were analyzed using Fisher exact test, two-sample t-test, and multivariable logistic regression. The incidence of PH in our cohort was 12%. Infants with PH had lower birth weights and gestational ages (p < 0.001). After controlling for confounding variables, severe BPD (p < 0.001), and higher Clinical Risk Index for Babies (CRIB) scores (p = 0.04) were associated with the development of PH. Severe BPD increases the risk for developing PH. Higher CRIB scores correlate with PH development in infants with BPD. We speculate that CRIB scores may allow for early categorization of preterm infants with a higher likelihood of developing PH.

Asymmetric dimethylarginine and l-arginine levels in neonatal sepsis and septic shock

Objective: Nitric oxide (NO) formed by the enzyme NO synthase (NOS) from l-arginine, is an important mediator for pathogen elimination. Being a potent vasodilator NO is implicated in hypotension and decreased organ perfusion in sepsis. Asymmetric dimethylarginine (ADMA) is an endogenous NOS inhibitor. We investigated ADMA and l-arginine levels in neonatal sepsis and their relation to disease severity.Methods: A prospective controlled study was conducted including 31 neonates with sepsis and 20 controls. Serum ADMA and l-arginine levels were measured within 24 h of sepsis diagnosis. Clinical and laboratory data including clinical risk index for babies (CRIB) score, presence of septic shock, organ dysfunction and death were recorded.Results: l-Arginine and ADMA levels were higher in neonates with sepsis compared to controls (p = 0.029 and p = 0.001, respectively). Neonates with septic shock had higher ADMA levels compared to septic neonates without shock (p = 0.026) and controls (p < 0.001). l-Arginine levels were higher in neonates with septic shock compared to septic neonates without shock (p = 0.012) and controls (p < 0.001). Survivors and non-survivors had similar l-arginine and ADMA levels. ADMA levels were correlated with CRIB score (rho = 0.320, p = 0.025).Conclusion: l-arginine and ADMA levels are elevated in neonatal sepsis and even higher levels are observed in septic shock.

Does the neonatal clinical risk for illness severity influence pain reactivity and recovery in preterm infants?

The biobehavioural pain reactivity and recovery of preterm infants in the neonatal period may reflect the capacity of the central nervous system to regulate neurobiological development. The aim of the present study was to analyse the influence of the neonatal clinical risk for illness severity on biobehavioural pain reactivity in preterm infants. Fifty-two preterm infants were allocated into two groups according to neonatal severity of illness, as measured by the Clinical Risk Index for Babies (CRIB). The low clinical risk (LCr) group included 30 neonates with CRIB scores <4, and the high clinical risk (HCr) group included 22 neonates with CRIB scores ≥4. Pain reactivity was assessed during a blood collection, which was divided into five phases (baseline, antisepsis, puncture, recovery-dressing and recovery-resting). Behavioral pain reactivity was measured using the scores, and magnitude of responses in Neonatal Facial Coding System (NFCS) and Sleep-Wake States Scale (SWS). The heart rate was continuously recorded. The HCr demonstrated a higher magnitude of response on the SWS score from the baseline to the puncture phase than the LCr. Also, the HCr exhibited a higher mean heart rate and minimum heart rate than the LCr in the recovery-resting phase. In addition, the HCr exhibited a higher minimum heart rate from the baseline to the recovery-resting phase than the LCr. The infants exhibiting a high neonatal clinical risk showed high arousal during the puncture procedure and higher physiological reactivity in the recovery phase.

A psychoneuroimmunologic examination of cumulative perinatal steroid exposures and preterm infant behavioral follow-up.

This study's aim was to explore relationships between preterm infant behavioral outcomes and maternal/infant glucocorticoid (dexamethasone [DEX]) treatments using a psychoneuroimmunologic approach. Research questions were (a) do relationships exist between infant cumulative perinatal steroid (PNS) exposure and child behavioral problems? and (b) do maternal/infant characteristics (e.g., immune markers and biophysiologic stressors) influence these relationships? The convenience sample comprised 45 mother-child dyads in which the children (mean age 8 years ± 2.3) had been born at a mean postconceptional age of 28 weeks (± 4.2). We used the Child Behavior Checklist (CBCL) to assess behavior, the Clinical Risk Index for Babies (CRIB) to score stress at birth, and retrospective record review to identify additional perinatal factors (PNS dosage, sepsis, and maternal and infant complete blood counts near delivery). Children were dichotomized into high (> 0.2 mg/kg; n = 20) versus low-no (≤0.2 mg/kg; n = 25) PNS exposure groups. Significant relationships existed between CBCL Total Problems score and sepsis, PNS exposure, timing of initial PNS, and infant length percentile at discharge. Competence problems were significantly associated with PNS, neonatal intensive care unit (NICU) infant length percentile, CRIB score, sepsis, retinopathy of prematurity, hearing deficit, and immunity markers (i.e., maternal lymphocyte percentage and infant band/seg ratio). Children in the higher PNS group exhibited more behavioral problems (e.g., withdrawn, attention, conduct, social, and rule breaking problems), but there were no significant differences. The findings are reassuring regarding long-term effects of this PNS dose on preterm infant behavioral outcomes.

92 Impaired Cerebral Autoregulation is Associated with Increased Blood Pressure Variability in Preterm Infants

Background: Impaired cerebral autoregulation is a key pathogenic factor in preterm cerebral injury, but the association of blood pressure variability (BPV) with autoregulatory impairment is unknown. We hypothesized that increased BPV in sick preterm infants leads to cerebral autoregulatory impairment. Using spectral analysis, we aimed to determine autoregulatory capacity in the early postnatal period, assessed by the correlation between mean arterial blood pressure (MABP, mmHg) and cerebral oxygenation (tissue oxygenation index, TOI %), and its relation with BPV(mmHg2)Method: Twenty-seven preterm infants of mean gestational age of 26.3 (± 1.3) weeks were studied on the first 3 postnatal days. TOI was continuously measured by Spatially Resolved Spectroscopy (Hamamatsu NIRO 200) together with MABP from an arterial catheter. Spectral coherence analysis was used to assess concordance between MABP and TOI, expressed as Coherence score (Coh) with a value of >0.5 suggesting impaired autoregulation. BPV was assessed using power spectral density of MABP.Results: In the frequency range 0.003-0.02Hz, BPV and maximum Coh showed a significant correlation (p=0.03). The median (IQR) minimum BPV associated with Coh >0.5 was lower in the very sick infants with Clinical Risk Index for Babies (CRIB) score of >7, compared with infants with CRIB score < 7 [29.7 (24.7-76.9) vs 99.7 (79.6 - 208.4) mmHg2, p=0.03]Conclusions: Cerebral autoregulatory impairment is associated with increased BPV, though this occurs with a comparatively lower level of BPV in extremely sick preterm infants. Our findings suggest that the sickest preterm infants are more vulnerable to cerebral injury from BPV.

Incidência e gravidade da retinopatia da prematuridade e sua associação com morbidade e tratamentos instituídos no Hospital Universitário Antonio Pedro, entre 2003 a 2005

To evaluate the incidence and the severity of retinopathy of prematurity (ROP) in preterm infants (PTI), its association with morbidity, and the treatments instituted at Antonio Pedro Hospital from the Universidade Federal Fluminense, between the years of 2003 and 2005. Transversal and retrospective study performed with 73 PTI, with gestational age (GA) of 32 weeks or less and/or birth weight (BW) of less than 1,500 g. Ophthalmoscopic exam was accomplished between 4 and 6 weeks of chronologic age or within the 32nd to 36th week of postconceptional age. The following data were registered: prenatal check-up, mode of delivery, gestational and childbirth complications, gender, BW, GA, weight-gestational age classification, FiO2 maximum value, oxygen use, presence of patent ductus arteriosus, intracranial hemorrhage, sepsis, necrotizing enterocolitis, blood transfusion, and surfactant use. CRIB (Clinical Risk Index for Babies) was used as severity score. Among the studied newborns, 34 did not present retinopathy of prematurity (46.6%). Out of the 53.4% that presented retinopathy of prematurity, 13 had retinopathy of prematurity 1 (17.8%), 20 had retinopathy of prematurity 2 (27.4%) and 6 had retinopathy of prematurity 3 (8.2%). Male newborns corresponded to 45.2% of the sample. 83% of the mothers accomplished prenatal care, 64% presented complications in the gestation period and 38% during the delivery. Cesarean section was the most frequent delivery mode (69%). All preterm infant belonged to the same CRIB score. About half of the sample was small-for-date (49.3%). The lowest GA and BW (p<0.001) were associated to the occurrence and severity of retinopathy of prematurity. The more severe cases of retinopathy of prematurity were associated to higher FiO2 average values. Longer periods of oxygen therapy use were associated with more severe retinal disease (p<0.05). Apgar score at the 5th minute was not related to the occurrence of retinopathy of prematurity (p=0.743). Among the representative variables of treatment and morbidity, just blood transfusion was included in the studied model from multivariate analysis through hierarchical logistic regression. Although preterm infant features explained partly their influence on the genesis of the disease, blood transfusion was associated to a higher chance of retinopathy of prematurity.