[Predictive value of the "Clinical Risk Index for Babies" for the risk of neonatal death]. / Valor preditivo do "Clinical Risk Index for Babies" para o risco de mortalidade neonatal.

OBJECTIVE: Several indicators, mainly birthweight and gestational age, have been used to predict the mortality risk in neonatal intensive care units. In order to assess the potential value of CRIB in predicting neonatal mortality, the score was used over the first 12 hours of life of the newborns admitted to this unit, during the year of 1996. METHOD: The inclusion criteria consisted of all infants without inevitably lethal congenital malformations, birthweight below 1,500 g and/or gestational age less than 31 weeks. Newborn children who died within 12 hours after delivery were excluded. The CRIB score covers birth weight, gestational age, the presence of congenital malformations (not inevitably lethal) and three indexes of physiological status during first 12 hours after birth-maximum and minimum appropriate fraction of inspired oxygen and maximum (most acidotic) base excess. RESULTS: In a prospective cohort, seventy one newborn children were studied. The birthweight (average) was 1,119 +/- 275.6 g, gestational age 30 weeks 4/7 +/- 2 weeks 3/7; male (57%); Apgar 1(0) min. score < or = 3 (36.2%) and Apgar 5 degrees min. score < 5 (5.8%). The mortality rate was 29.6% (gold standard). But mortality rate by birthweight less than 1,000 gr. or gestational age lower than 29 weeks was 60.0% and for the CRIB score above 10 was 100%. DISCUSSION: The specificity and predictive positive values for CRIB score above 10 were greater than any other two parameters. The area under the receiver operating characteristic (ROC) curve for predicting death was significantly greater for CRIB than for birthweight alone. It was concluded that the CRIB score is a better predictive indicator for mortality than are birthweight and gestational age.

PCR in the first oropharynx aspirate of the newborn: a possible source for identification of congenital infection agents

Relatamos um caso de diagnostico pre-natal de rubeola congenita. Apos o nascimento, alem da confirmacao feita atraves do exame fisico e sorologico do recem-nascido, o virus tambem pode ser demonstrado no primeiro fluido aspirado da orofaringe do recem-nascido, utilizando-se a reacao em cadeia da polimerase (PCR). Sugerimos que este fluido (colhido rotineiramente no momento da reanimacao neonatal) possa ser utilizado na pesquisa de outros agentes infecciosos, que nao sao facilmente identificados por outros metodos

PCR in the first oropharynx aspirate of the newborn: a possible source for identification of congenital infection agents.

We present a case of prenatal diagnosis of congenital rubella. After birth, in addition to traditional serologic and clinical examinations to confirm the infection, we could identify the virus in the "first fluid aspirated from the oropharynx of the newborn", using polimerase chain reaction (PCR). We propose that this first oropharynx fluid (collected routinely immediately after birth) could be used as a source for identification of various congenital infection agents, which may not always be easily identified by current methods.