Clinical Risk Index For Babies Research Articles

Validation of the crib ii score for predicting very low birth weight infants’ mortality

Objective- To validate Clinical Risk Index for Babies (CRIB II) score in predicting the mortality of preterm, VLBW babies and to study the correlation of risk factors with Clinical Risk Index for Babies(CRIB II) Methods- A Prospective observational study was done in Preterm, VLBW neonates admitted in our neonatal intensive care unit (NICU)over a period of 1 year from November 2021 to December 2022 in 50 subjects. Result Out of 50 VLBW neonates, 32 (64%) were level 1 score, 12 (24.00%) were level 2 score, 5 (10.00%) were level 3, 1 (2%) were level 4 score. Out of 50 VLBW babies, 32 (64%) were survived and 18(36%) were expired. There is a strong, negative correlation between CRIB II score and birth weight of infants with p 0.001 and r=-0.79 Conclusion-. The present study concludes that CRIB II a score is effective in predicting the mortality in VLBW babies. Survival is more among babies in level 1 score. The more the CRIB II score, the less is the chance of survival.

Evaluating the Clinical Risk Index for Babies (CRIB) II Score for Mortality Prediction in Preterm Newborns: A Prospective Observational Study at a Tertiary Care Hospital.

Neonatal mortality is an issue that affects both the developed and developing world. It is very important in the neonatal intensive care unit (NICU) to do the assessment of the severity of neonatal illness, which in turn helps in estimating and preventing mortality in the NICU by improving healthcare control and by rational use of resources. This research was carried out to evaluate how effectively theClinical Risk Index for Babies (CRIB) II score can predict mortality rates among newborns treated in our NICU. Methodology: This prospective observational study spanned one year, commencing in October 2021 and concluding in September 2022, within the confines of our NICU. The CRIB II score calculation was performed for included newborns, and the outcomes of the newborns were compared. A receiver operating characteristic (ROC) curve was obtained to ascertain the optimal CRIB II cut-off score for predicting mortality. Within the designated research timeframe, 292 neonates were admitted to the NICU. Forty-four newborns were enrolled in the study. Preterm neonates who died had higher CRIB II scores than those who survived, and their median (IQR) was 6 (1-12) vs. 9.5 (5-14) (p=0.0003). The estimate for the area under the curve was 0.83 (95% CI 0.68-0.92), and the odds ratio of 2.56 suggests neonates with a higher CRIB II score have higher chances of mortality. The CRIB II score is very good at predicting mortality in preterm newborns.

Comparing different scoring systems for predicting mortality risk in preterm infants: a systematic review and network meta-analysis.

This study aimed to compare the predictive values of eight scoring systems (Neonatal Critical Illness Score [NCIS], Neonatal Therapeutical Intervention Score System [NTISS], Clinical Risk Index for Babies [CRIB], Clinical Risk Index for Babies II [CRIB-II], Score for Neonatal Acute Physiology Perinatal Extension [SNAPPE], Score for Neonatal Acute Physiology Perinatal Extension II [SNAPPE-II], Score for Neonatal Acute Physiology [SNAP], and Score for Neonatal Acute Physiology II [SNAP-II]) for the mortality risk among preterm infants. The Embase, PubMed, Chinese Biomedical Database, Web of Science, and Cochrane Library databases were searched to collect studies that compared different scoring systems in predicting the mortality risk in preterm infants from database inception to March 2023. Literature screening, data extraction, and bias risk assessment were independently conducted by two researchers. Subsequently, the random-effects model was used for the network meta-analysis. A total of 19 articles were included, comprising 14,377 preterm infants and 8 scoring systems. Compared to CRIB-II, NCIS, NTISS, SNAP-II, and SNAPPE-II, CRIB demonstrated better predictive efficiency for preterm infant mortality risk (P < 0.05). Relative to CRIB, CRIB-II, and SNAPPE, SNAP-II had worse predictive efficiency for preterm infant mortality risk (P < 0.05). The surface under the cumulative ranking curve of the eight scoring systems was as follows: CRIB (0.980) > SNAPPE (0.718) >SNAP (0.534) >CRIB-II (0.525) >NTISS (0.478) >NCIS (0.422) >SNAPPE-II (0.298) >SNAP-II (0.046). The CRIB scoring system showed the highest accuracy in predicting preterm infant mortality risk and was simple to perform. Therefore, CRIB selection can be prioritized in clinical practice. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=434731, PROSPERO (CRD42023434731).

Validity of the Mean Platelet Volume and Revised Clinical Risk Index for Babies (CRIB-II) Score to Assess Mortality Risk in Preterm Infants

Objective: This study aimed to investigate the validity of the mean platelet volume (MPV) alone and MPV combined with the revised Clinical Risk Index for Babies (CRIB II) score to predict neonatal mortality in preterm infants. Materials and Methods: This retrospective observational study performed between May 2018 and June 2021 included preterm neonates (gestational age 23–32 weeks) admitted to a tertiary neonatal intensive care unit (NICU) within 12 hours of birth, who were followed up until death or discharge. MPV was recorded at admission and within 72 hours before death or discharge. The CRIB II score variables were assessed within 12 hours of birth, and the area under the receiver operating characteristic curve (AUC) was calculated for the MPV and CRIB II scores to predict neonatal mortality. Results: We investigated 404 newborns, of whom 28 (6.9%) died. The mean neonatal gestational age was 28.6±2.8 weeks. The MPV was significantly higher in non-survivors than in survivors (p=0.001). The AUC for the MPV and the CRIB II score was 0.68 (95% CI: 0.55–0.80) and 0.85 (95% CI: 0.79–0.91), respectively. The AUC for the MPV combined with the CRIB II score was 0.91 (95% CI 0.87–0.95). The difference in MPV at birth between survivors and non-survivors was statistically non-significant. Conclusion: MPV was found to be a poorer predictor of neonatal mortality than the CRIB II score; however, MPV combined with the CRIB II score demonstrated significantly improved predictive ability for preterm infant mortality risk.

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants.

There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life. This is a retrospective medical records review of 23 +0-28 +6 weeks' gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) >30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens. Babies admitted after 12 hours of age, or whose BP data were not available were excluded. There were 764 infants admitted to the participating hospitals; 671 (88%) were included in the analysis (263 active BP support and 408 permissive BP support). The mean gestational age, birth weight, admission temperature, clinical risk index for babies (CRIB) score and first haemoglobin of infants were comparable between the groups. Active BP support group infants had consistently higher MABP and systolic BP throughout the first 72 hours of life (p<0.01). In the active group compared to the permissive group 56 (21.3%) vs 104 (25.5%) babies died, and 21 (8%) vs 51 (12.5%) developed >grade 2 intra ventricular haemorrhage (IVH). Death before discharge (adjusted OR 1.38 (0.88 - 2.16)) or IVH (1.38 (0.96 - 1.98)) was similar between the two groups. Necrotising enterocolitis (NEC) ≥stage 2 was significantly higher in permissive BP support group infants (1.65 (1.07 - 2.50)). There was no difference in mortality or IVH between the two BP management approaches. Active BP support may reduce NEC. This should be investigated prospectively in large multicentre randomised studies.

VALIDATION OF CRIB II SCORE IN PREDICTING MORTALITY OF VERY LOW BIRTH WEIGHT INFANTS

Objective:To validate Clinical Risk Index for Babies (CRIBII) score in predicting the mortality of preterm, VLBW babies and to study the correlation of risk factors with Clinical Risk Index for Babies (CRIB II) score Methods:AProspective observational study was done in Preterm, VLBW neonates admitted in SNCU GGH Kurnool overa period of 1 year from November 2021 to December 2022 in 60 subjects. Result:Out of 60 VLBW neonates, 38 (63.33%) were level 1 score, 15 (25.00%) were level 2 score, 6 (10.00%) were level 3, 1 (1.67%) were level 4 score. Out of 60VLBW babies, 38 (63.33%) were survived and 22 (36.67%) were expired.There is a strong,negative correlation between CRIB II score and birth weight of infants with p 0.001 andr=-0.79 Conclusion:The present study concludes that CRIB II score is effective in predicting the mortality in VLBW babies. Survival is more among babies in level 1 score.The more the CRIB II score, the less is the chance of survival.

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants

Background There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life. Method This is a retrospective medical records review of 23+0–28+6 weeks’ gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) &gt;30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens. Babies admitted after 12 hours of age, or whose BP data were not available were excluded. Results There were 764 infants admitted to the participating hospitals; 671 (88%) were included in the analysis (263 active BP support and 408 permissive BP support). The mean gestational age, birth weight, admission temperature, clinical risk index for babies (CRIB) score and first haemoglobin of infants were comparable between the groups. Active BP support group infants had consistently higher MABP and systolic BP throughout the first 72 hours of life (p&lt;0.01). In the active group compared to the permissive group 56 (21.3%) vs 104 (25.5%) babies died, and 21 (8%) vs 51 (12.5%) developed &gt;grade 2 intra ventricular haemorrhage (IVH). Death before discharge (adjusted OR 1.38 (0.88 – 2.16)) or IVH (1.38 (0.96 – 1.98)) was similar between the two groups. Necrotising enterocolitis (NEC) ≥stage 2 was significantly higher in permissive BP support group infants (1.65 (1.07 – 2.50)). Conclusions There was no difference in mortality or IVH between the two BP management approaches. Active BP support may reduce NEC. This should be investigated prospectively in large multicentre randomised studies.

STARZ Neonatal AKI Risk Stratification Cut-off Scores for Severe AKI and Need for Dialysis in Neonates

Neonatal acute kidney injury (AKI) is a significant pathology associated with higher mortality rates, longer neonatal intensive care stay, and worse clinical outcomes.1,2 In order to mitigate the avoidable outcomes, it is important to identify AKI early and start early therapeutic measures.2,3 There have been previous attempts to derive illness severity scores, such as the Clinical Risk Index for Babies, the Simplified age-weight-sex score, Pediatric Risk of Mortality and Pediatric Index of Mortality among neonates and children.

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

Accuracy of CRIB II Score in Predicting the Neonatal Mortality in very Preterm Babies

Objective: To determine the accuracy of Clinical Risk Index for Babies (CRIB) II score to predict mortality in very preterm babies. Methodology: In this cross-sectional study at Neonatal Intensive Care Unit (NICU) of The Children's Hospital, Lahore, 145 very preterm neonates admitted in NICU were enrolled. We determined gestational age, weight, rectal temperature and base excess for both genders within first hour of the admission. The collected data was entered on CRIB II score chart and risk of mortality was calculated. The babies were reviewed daily in NICU till final outcome (mortality or no mortality). Results: In this study, out of 145 patients, 47.59%(n=69) were females and 52.41%(n=76) were males. Mean+SD for gestational age, birth weight, rectal temperature, base excess and CRIB II score was 29.90+1.70 weeks, 1171.31±192.16 grams, 36.92+0.39 degrees Celsius, -3.63±6.63 and 5.03±3.04 respectively. Actual mortality rate was 36.55%(n=53) whereas 63.45%(n=92) had no mortality; Predicted mortality rate on CRIB II score was 41.38% (n=60) whereas 58.62%(n=85) had no mortality. Accuracy of CRIB II score to predict mortality in very preterm babies admitted in NICU of The Children's Hospital, Lahore was 84.14%. It had sensitivity of 84.91%, specificity of 83.70%, (PPV) of 75.00% and (NPP) of 90.58 %. Area under the receiver operating characteristics (ROC) curve was 0.840 (std. error=0.035; p-value=0.000). Conclusion: We concluded that CRIB II score is a valid clinical score with higher accuracy to predict neonatal mortality in very preterm babies. Keywords: Very Preterm Babies, Neonatal Mortality, CRIB II Score, Predictive Accuracy

Multiple organ dysfunction syndrome prediction in newborn children

There are several directions for predicting multiple organ dysfunction syndrome (MODS), but almost all of them are poorly tested in neonatology. This review is presented to indicate the problem of the condition severity objectification of newborns and the possibility of predicting the development of MODS. Scales for assessing the severity of MODS in critically ill children have been developed and used since the end of the last century, but their validation in the newborns faces certain difficulties. Prognostic nosospecific scales: NICHD (National Institute of Child Health and Human Development) calculator, CRIB II (Clinical Risk Index for Babies), SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal Extension II) are used in neonatology, however their comparison in this category of patients has not been carried out.Theoretical and practical issues of the short-term and long-term prediction of the MODS onset and its outcomes in newborns is a promising area of neonatology, since it allows a doctor to be warned about an impending catastrophe and opens a “window of opportunity” for timely correction of treatment tactics and complications prevention. Obtaining different phenotypes of critical illness and predicting their outcomes in children may have good predictive potential, but such studies have not been conducted in newborns. A promising direction in predicting MODS is the identification of biomarkers of inflammation, among which endocan, cluster of differentiation 64, cluster of differentiation molecules 11b, “pancreatic stone protein” (PSP), soluble intercellular adhesionmolecule-1 (sICAM-1), progranulin, neopterin, resistin (FIZZ3, presepsin (PSP)) carry a good potential, but their effectiveness in neonatology is still to be investigated.Thus, the prediction of MODS in children and newborns remains an unresolved problem. At the same time, several promising scientific directions are actively being developed today, which may lead to a significant breakthrough in predicting MODS in neonatology.

Comparison of different neonatal illness severity scores in predicting mortality risk of extremely low birth weight infants.

To compare different illness severity scores in predicting mortality risk of extremely low birth weight infants (ELBWI). From January 1st, 2019 to January 1st, 2020, all ELBWI admitted in the Children's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital and the First Affiliated Hospital of Nanjing Medical University were included in the study. ELBWI with admission age ≥1 h, gestational age ≥37 weeks and incomplete data required for scoring were excluded. The clinical data were collected, neonatal critical illness score (NCIS), score for neonatal acute physiology version Ⅱ (SNAP-Ⅱ), simplified version of the score for neonatal acute physiology perinatal extension (SNAPPE-Ⅱ), clinical risk index for babies (CRIB) and CRIB-Ⅱ were calculated. The scores of the fatal group and the survival group were compared, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above illness severity scores for the mortality risk of ELBWI. Pearson correlation analysis was used to analyze the correlation between illness scores and birth weight, illness scores and gestational age. A total of 192 ELBWI were finally included, of whom 114 cases survived (survival group) and 78 cases died (fatal group). There were significant differences in birth weight, gestational age and Apgar scores between fatal group and survival group (all <0.01). There were significant differences in NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ between fatal group and survival group (all <0.01). The CRIB had a relatively higher predictive value for the mortality risk. Its area under the ROC curve (AUC) was 0.787, the sensitivity was 0.678, the specificity was 0.804, and the Youden index was 0.482. The scores of NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ were significantly correlated with birth weight and gestational age (all <0.05). The correlation coefficients of CRIB-Ⅱ and CRIB with birth weight and gestational age were relatively large, and the correlations coefficients of NCIS with birth weight and gestational age were the smallest (0.191 and 0.244, respectively). Among these five illness severity scores, CRIB has better predictive value for the mortality risk in ELBWI. NCIS, which is widely used in China, has relatively lower sensitivity and specificity, and needs to be further revised.

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 (&lt; 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.&#x0D; 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.&#x0D; 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).&#x0D; Results: There was a weak positive correlation between MHSS score for neonatal infection and both of the SNAP II and CRIB scores.&#x0D; 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.

Prognostic Models Predicting Mortality in Preterm Infants: Systematic Review and Meta-analysis.

Prediction models can be a valuable tool in performing risk assessment of mortality in preterm infants. Summarizing prognostic models for predicting mortality in very preterm infants and assessing their quality. Medline was searched for all articles (up to June 2020). All developed or externally validated prognostic models for mortality prediction in liveborn infants born <32 weeks' gestation and/or <1500 g birth weight were included. Data were extracted by 2 independent authors. Risk of bias (ROB) and applicability assessment was performed by 2 independent authors using Prediction model Risk of Bias Assessment Tool. One hundred forty-two models from 35 studies reporting on model development and 112 models from 33 studies reporting on external validation were included. ROB assessment revealed high ROB in the majority of the models, most often because of inadequate (reporting of) analysis. Internal and external validation was lacking in 41% and 96% of these models. Meta-analyses revealed an average C-statistic of 0.88 (95% confidence interval [CI]: 0.83-0.91) for the Clinical Risk Index for Babies score, 0.87 (95% CI: 0.81-0.92) for the Clinical Risk Index for Babies II score, and 0.86 (95% CI: 0.78-0.92) for the Score for Neonatal Acute Physiology Perinatal Extension II score. Occasionally, an external validation study was included, but not the development study, because studies developed in the presurfactant era or general NICU population were excluded. Instead of developing additional mortality prediction models for preterm infants, the emphasis should be shifted toward external validation and consecutive adaption of the existing prediction models.

The CRIB II (Clinical Risk Index for Babies II) Score in Prediction of Neonatal Mortality.

Predicting the outcome of neonatal critical patients remains elusive. The multiple factors of maternal state of health (infections, diabetes, gestosis), the placental situation (premature rupture of membranes) as well as multiple factors from the baby (small for gestational age, low Apgar score, low birth infections, mechanical ventilation, hypoglycaemia hyperglycamiea) render the approach to treatment of each patient individual and the outcome uncertain. Several approaches and scales are developed in order to assess the mortality risk in those rather complicated situations.We used the CRIB-II scale to assess the mortality risk in 80 patients delivered in a large tertiary level hospital with more than 4,000 deliveries yearly. The patients were stratified according to all the neonatal risk factors and comorbidities. The CRIB-II scale identified well the mortality rates, but not the outcomes. A large and well-balanced cohort of patients followed for a longer period is required to discern in detail the importance of CRIB-II scale in predicting outcomes in high-risk new-borns. This could serve as an assistance to personalized approach to severely sick children. In addition, it is a valuable method in comparing outcomes in different NICUs and outcomes in different times in the same NICU, thus rendering possible improvements in the same unit and among several NICU departments.

Determination of Predictive Power of CRIB-II and SNAPPE-II in Mortality Risk of Neonates with Low Gestational Age or Birth Weight Admitted to the Neonatal Intensive Care Unit

Background: Risk scoring systems evaluate neonatal outcomes using perinatal and neonatal status. The present study aimed to predict the mortality risk of preterm or low birth weight infants using the Clinical Risk Index for Babies (CRIB-II) and Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE-II) scoring systems.Methods: This prospective cohort study investigated the preterm neonates admitted to the Neonatal Intensive Care Unit (NICU) of Vali-e-Asr Hospital, Tehran, Iran, with the birth weight of ˂1500g or a gestational age˂32weeks using the CRIB-II and SNAPPE-II scoring systems within the first 12 h after birth. The area under the curve, sensitivity, specificity, positive and negative predictive values of the scoring systems, as well as the association between neonate factors and neonatal death were calculated in this study.Results: Out of 344 neonates under study, 253casessurvived after24hof birth and 91 newborns died. The total CRIB-II scores in survived and deceased infants were 6.12 and 10.28, respectively. The area under the receiver operating characteristic (ROC) curve with a cut-off point of 8.5 was obtained at 0.838. Moreover, the sensitivity, specificity, positive predictive value, and negative predictive value were estimated at 74.4%, 78.65%, 55.37%, and 89.68%, respectively, for the CRIB-II system. Total scores of SNAPPE-II in survived and deceased infants were 16.9 and 51.6, respectively. The area under the ROC curve with a cut-off point of 27.5 was determined at 0.887. Sensitivity (84.44%) and specificity (79.05%) were calculated for the SNAPPE-II. Furthermore, positive and negative predictive values were 58.91% and 93.46%, respectively.Conclusion: This study demonstrated that the CRIB-II and SNAPPE-II scoring systems can be useful mortality predictors for at-risk neonates.

Oral ibuprofen promoted cholestatic liver disease in very low birth weight infants with patent ductus arteriosus

Hemodynamically significant patent ductus arteriosus (hsPDA) in very low birth weight (VLBW) infants is routinely treated in many countries with oral ibuprofen. This study retrospectively assessed whether the risk of cholestatic liver disease (CLD) increased due to oral ibuprofen administration in VLBW infants. A total of 122 VLBW preterm infants (26∼32 weeks, birth weight<1500g) diagnosed with patent ductus arteriosus (PDA) admitted to our neonatal intensive care unit (NICU) between September 2016 to August 2018 were included. Sixty-four infants were diagnosed with hs-PDA and received ibuprofen treatment. VLBW infants with PDA untreated with ibuprofen served as controls. Soybean oil and fat emulsions were routinely added to parenteral nutrition (PN). Once CLD was diagnosed, the fat emulsions were immediately replaced with multi-oil fat emulsion injections. To assess the independent association of treatment and duration of ibuprofen with CLD and duration of fasting and PN, binary logistic regression or multivariate linear regression analyses were conducted, adjusting for major confounders (birth weight, gestational age, Clinical Risk Index for Babies, and cholestasis-associated risk factors). The duration of PN increased due to ibuprofen treatment for 6.559 days (95% CI: 1.769, 11.349; P=0.008), and the risk of prolonged fasting (cutoff>5 days) might have increased due to ibuprofen treatment (OR: 3.043, 95% CI: 0.965, 9.594; P=0.057). Furthermore, CLD was influenced by ibuprofen treatment (OR: 6.730; 95% CI: 1.279, 35.41; P=0.024), early thrombocytopenia 7 days postnatal (OR: 6.996; 95% CI: 1.769, 27.658; P=0.004), and late onset sepsis (OR: 6.976; 95% CI: 1.561, 31.169; P=0.011). Further analysis adjusting for cholestasis-associated risk factors revealed that CLD was influenced by the duration of ibuprofen treatment (OR: 2.864; 95% CI: 1.104, 7.422; P=0.030), Platlets counts 7 days postnatal (OR: 0.971; 95% CI: 0.950, 0.994; P=0.013), and duration of antibiotics (OR: 1.134; 95% CI: 1.002, 1.282; P=0.046). This retrospective study indicated oral ibuprofen duration-dependently increased the risk of CLD in VLBW infants with PDA, and early thrombocytopenia served as the critical risk factor.

Clinical Risk Index for Babies (CRIB-II) Scoring System in Prediction of Mortality Risk in Preterm Neonates in the First 24 Hour

Background: The scoring systems evaluate neonatal outcomes based on perinatal factors in the Neonatal Intense Course Unit (NICU). Aim: This study aimed to predict mortality risk in preterm neonates for the first time, using the Clinical Risk Index for Babies (CRIB II). Method: This cross-sectional, descriptive-analytical, longitudinal study was conducted on 344 preterm neonates with the gestational age of 23-32 weeks and birth weight of 500-1500 g in a referral center in Tehran, Iran, from winter 2016 to spring 2017. Some neonatal variables were completed within the first 12 h of life, and the final scores were calculated based on CRIB II. Then, the correlation of these variables with mortality outcome was evaluated using logistic regression. Sensitivity, specificity, and positive and negative values were also calculated via SPSS software (version 23). Results: According to the results, 253 (73.57%) neonates, including 122 girls (48%), survived in the first 24 h after birth. The total CRIB II score in the surviving neonates was 6.1±2.6. The area under the receiver operating characteristic curve was estimated at 0.84 with the cut-off point of 8.5. In addition, the sensitivity, specificity, positive predictive value, and negative predictive value of the CRIB II system were obtained as 75%, 78%, 55%, and 89.5%, respectively. The results revealed a significant correlation between the CRIB II score and mortality outcome. In this regard, an increase in the CRIB score coincided with a 0.67 increase in the risk of death (OR=1.671, p <0.001). Implications for Practice: Based on the findings of the present study,CRIB II can be concluded to be an appropriate scoring system. Consequently, the result of this tool can be used for routine investigations.

Risk factors for postpartum depression in mothers of newborns admitted to neonatal intensive care unit

ABSTRACT Background There is a lack of information on how maternal stress coping styles during admission of the newborn to the neonatal intensive care unit (NICU) influences the onset of the postpartum depression (PPD). We examined potential risk factors for the emergence of the PPD in mothers whose infants were admitted to the NICU. Methods A cross-sectional study was conducted on 401 mothers, 125 were mothers whose infants were admitted to the NICU and 276 mothers without NICU care. Newborn illness severity information score was taken throughout NICU admission via the Clinical Risk Index for Babies (CRIB). Six weeks after giving birth, participants from both groups individually completed the Edinburg Postnatal Depression Scale (EPDS), the Postpartum Bonding Questionnaire (PBQ) and the Coping Strategies Inventory (CSI) using an online platform. Results No differences were found regarding PPD and bonding in either groups. Multivariate analysis provided a final model in which cognitive restructuring, problem avoidance, severity of neonatal health problems during the first 12 hours of life, and problem solving were the best predictors of postpartum depression explaining, 43.7% of the variance in the NICU group. Conclusion It is necessary to obtain early detailed information on coping styles in the NICU environment to prevent the possible onset of PPD.

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.