Is the CRIB score (clinical risk index for babies) a valid tool in predicting neurodevelopmental outcome inExtremely low birth weight infants?

The study aimed to assess how well the severity of clinical conditions in extremely low birth weight infants in the first 12 h of life, as measured by the CRIB (clinical risk index for babies), relates to hospital outcome and subsequent disability at 18 months of age. The CRIB was confirmed as a valid index of initial neonatal risk, even in extremely low birth weight infants, predicting hospital outcome (death or major brain lesions) more accurately than birth weight or gestational age. However, an adjustment of the CRIB score for gestational age might enhance its positive predictive value in relation to short-term developmental outcome in this particular population.

[Chronic idiopathic hypertransaminasemia]. / Ipertransaminasemia cronica idiopatica.

The elevation of aminotransferase serum levels is frequently encountered in pediatric practice. We have retrospectively evaluated the clinical patterns of 108 patients with chronic, so called "idiopathic", alterations of aminotransferases, by sending a questionnaire to 11 Italian Pediatric Centers. The average period of follow-up was 22 months. Patients, whose ages ranged through all pediatric ages, were mostly asymptomatic and with a rather insignificant physical examination. The average rise of aminotransferases value was generally limited within 2 times the upper normal level and the highest value, during the period of follow-up, never exceeded 5 times the upper normal level. Other liver function tests did not result generally altered significant. Just 25,9% of the patients normalized aminotransferases serum level during the follow-up period. All maintained good physical status with no clinical signs of liver disease. A muscular cause of hyper-transaminasemia was excluded in all the cases. Possible infective causes (HBV and HCV) autoimmune hepatitis, Wilson disease, alfa1 antitripsine deficiency and hyperammoniemia were excluded. Ultrasound investigation did not seem to be a sensitive investigation, resulting negative in 54/82. Histologic liver examination was more informative. This evaluation, performed in 46/108 patients, showed infarct metabolic alterations (steatosis, nucleus glucogenic degeneration, cytoplasmatic clarification) in 65% of cases and inflammatory findings in only 13% of cases. In conclusion, our results suggest the opportunity to enclose liver histologic study in the diagnostic approach of children with hepatic idiopathic chronic hypertransaminasemia. This approach may address the clinician, in a more aimed way, towards further investigations.