Comparison of CRIB-II with SNAPPE-II for predicting survival and morbidities before hospital discharge in neonates with gestation ≤ 32 weeks: a prospective multicentric observational study.

Various studies validated and compared Score for Neonatal Acute Physiology with Perinatal extension-II (SNAPPE-II) and Clinical Risk Index for Babies-II (CRIB-II) admission sickness severity scores for predicting survival, but very few studies compared them for predicting the morbidities in preterm infants. In this multicenter prospective observational study, SNAPPE-II and CRIB-II newborn illness severity scores were compared for predicting mortality and morbidities in infants with gestational age of ≤ 32 weeks. Major morbidities were classified as bronchopulmonary dysplasia, abnormal cranial ultrasound (presence of intraventricular hemorrhage grade III or more or periventricular leukomalacia grade II to IV), and retinopathy of prematurity requiring treatment. Combined adverse outcome was defined as death or any major morbidity. Comparison of the scoring systems was done by area under the curve (AUC) on receiver operating characteristics curve (ROC curve) analysis. A total of 419 neonates who were admitted to 5 participating NICUs were studied. The mortality rate in the study population was 8.8%. Both CRIB-II (AUC: 0.795) and SNAPPE-II (AUC: 0.78) had good predictive ability for in-hospital mortality. For predicting any one of the major morbidities and combined adverse outcome, CRIB-II had better predictive ability than SNAPPE-II with AUC of 0.83 vs. 0.70 and 0.85 vs. 0.74, respectively. CONCLUSION: In infants with gestational age of ≤ 32 weeks, both CRIB-II and SNAPPE-II are good scoring systems for predicting mortality. CRIB-II, being a simpler scoring system and having better predictive ability for major morbidities and combined adverse outcome, is preferable over SNAPPE-II. WHAT IS KNOWN: • SNAPPE-II and CRIB-II scores have good predictive ability on in-hospital mortality in preterm neonates. WHAT IS NEW: • SNAPPE-II and CRIB-II both have good predictive ability for mortality, but CRIB-II has better ability for short-term morbidities related to the prematurity.

Comparing CRIB-II and SNAPPE-II as mortality predictors for very preterm infants.

AIMS: This article compares the severity of illness scoring systems clinical risk index for babies (CRIB)-II and score for neonatal acute physiology with perinatal extension (SNAPPE)-II for discriminatory ability and goodness of fit in the same cohort of babies of less than 32 weeks gestation and aims to provide validation in the Australian population. METHODS: CRIB-II and SNAPPE-II scores were collected on the same cohort of preterm infants born within a 2-year period, 2003 and 2004. The discriminatory ability of each score was assessed by the area under the receiver operator characteristic curve, and goodness of fit was assessed by the Hosmer-Lemeshow (HL) test. The outcome measure was in-hospital mortality. A multivariate logistic regression model was tested for perinatal variables that might add to the risk of in-hospital mortality. RESULTS: Data for both scores were available for 1607 infants. Both scores had good discriminatory ability (CRIB-II area under the curve 0.913, standard error (SE) 0.014; SNAPPE-II area under the curve 0.907, SE 0.012) and adequate goodness of fit (HL χ2 = 11.384, 8 degrees of freedom, P = 0.183 for CRIB-II; HL χ2 = 4.319, 7 degrees of freedom, P = 0.742 for SNAPPE-II). The multivariate model did not reveal other significant variables. CONCLUSIONS: Both severity of illness scores are ascertained during the first 12 h of life and perform similarly. Both can facilitate risk-adjusted comparisons of mortality and quality of care after the first post-natal 12 h. CRIB-II scores have the advantage of being simpler to collect and calculate.

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.

Comparación de escalas de predicción mortalidad neonatal (crib, crib ii, snap ii, snappe ii) entre recién nacidos prematuros y a término / Comparison of neonatal mortality prediction scales (crib, crib ii, snap ii, snappe ii) between preterm and full term infants

Objetivo: Este artículo compara 4 escalas de predicción de mortalidad y gravedad de la enfermedad (CRIB, CRIB II, SNAPPE, SNAPPE II) en recién nacidos prematuros y a términos, ingresados a las unidades de cuidaos intensivos neonatales (UCIN) para determinar cuál de ellas, tiene mayor discriminación pronostica. Métodos: es un estudio transversal, observacional, multicéntrico para comparar varias escalas de predicción de mortalidad y de la enfermedad. Se recolectaron datos de 227 recién nacidos ingresados a las UCIN de 4 hospitales desde julio a diciembre del 2018. Evaluamos las escalas CRIB, CRIB II, SNAPII y SNAP-PE score en recién nacidos prematuros y a término. El área bajo la curva (ROC) fue usada para evaluar y comparar los resultados de predicción de mortalidad y morbilidad. Resultados: Un total of 227 recién nacidos fueron evaluados (media CRIB: 7,81±3,52 media CRIB-II: 11,96±3,91; media SNAP-II: 34,99±16,83, SNAPPE II: 14,61±13,30). Se evidenció una mayor discriminación para las escalas CRIB II y CRIB en relación con SNAP-II y SNAPP II (AUC 0.94 y 0.93 vs 0.86 y 0,77). Además de cada puntuación, varias variables influyeron significativamente en la supervivencia en los modelos de regresión logística. Conclusiones: Todas las escalas de predicción de mortalidad y de gravedad de la enfermedad sirven para utilizarse en las UCIN estudiadas, siendo la escala CRIB II la de mejor rendimiento para aplicarse en nuestro medio.

Objective: This article compares 4 scales of prediction of mortality and disease severity (CRIB, CRIB II, SNAPPE, SNAPPE II) in preterm and term new borns admitted to neonatal intensive care units (NICU) to determine which of them has greater forecast discrimination. Methods: it is a cross-sectional, observational, multicenter study that compares several mortality and disease prediction scales. Data were collected from 227 newborns admitted to the NICU of 4 hospitals from July to December 2018. We evaluated the CRIB, CRIB II, SNAPII and SNAP-PE score scales in preterm and full term infants. The area under the curve (ROC) was used to evaluate and compare the prediction results of mortality and morbidity. Results: A total of 227 newborns were evaluated (mean CRIB: 7.81 ± 3.52 mean CRIB-II: 11.96 ± 3.91, average SNAP-II: 34.99 ± 16.83, SNAPPE II: 14.61 ± 13.30). There was evidence of greater discrimination for the CRIB II and CRIB scales in relation to SNAP-II and SNAPP II (AUC 0.94 and 0.93 vs 0.86 and 0.77). In addition to each score, several variables significantly influenced survival in the logistic regression models. Conclusions: All the prediction scales of mortality and severity of the disease serve to be used in the studied NICUs, being the CRIB II scale the best performance to apply in our environment.