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100 Neonatal Disease Severity Scores and their Predictive Value 3For Early Mortality: A Population-Based Study on Subgroups of VLBW Infants
  1. R Hentschel1,
  2. K Günther1,
  3. W Vach2,
  4. M Teufel3,
  5. T Böhler4,
  6. M Mohrmann5,
  7. J Arand6,
  8. I Dick7,
  9. I Bruder8,
  10. W Kachel9
  1. 1Neonatology/Intensive Care, Center for Pediatrics and Adolescent Medicine University of Freiburg
  2. 2Div. Clinical Epidemiology, Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg im Breisgau
  3. 3Dept. Pediatrics, Academic Hospital Sindelfingen-Böblingen, Böblingen
  4. 4Medical Service of Statutory Health Insurance Companies (MDK) Baden-Württemberg, Karlsruhe
  5. 5Medical Service of Statutory Health Insurance Companies (MDK) Baden-Württemberg, Lahr
  6. 6Div. Neonatology, Univ. Children’s Hospital Tübingen, Tuebingen
  7. 7Registry of Neonatal Quality Assurance Program, Baden-Württemberg Chamber of Physicians
  8. 8Registry of Baden-Württemberg Hospital Quality Assurance (GeQiK), Stuttgart
  9. 9Dept. Pediatrics, Academic Hospital Heilbronn, Heilbronn, Germany

Abstract

Background and aims Benchmarking of newborn mortality needs risk-adjustment of data for heterogeneous sub-populations. To assess utility of neonatal disease severity scores CRIB, CRIB-II and PREM and impact of influenceable items (FiO2max, FiO2min, body temperature (BT) base excess (BE)) to predict mortality in VLBW infants (VLBW), ELBW infants < 750g (BW750), g.a. 22–25 weeks (GA22–25).

Methods Analysis of birth cohorts of years 2003–2008 from the Baden-Württemberg registry. Inclusion criteria: GA < 33 weeks and BW < 1.500g. Variables considered: GA; BW; gender; BT; FiO2max; FiO2min; BE; malformation; death. Calculation of standard CRIB, CRIB-II and PREM with/without omission of selective items. Calculation of predictive value of scores/subscores for whole cohort VLBW, subgroups BW750 and GA22-25 using AUC of ROC curves. Wilcoxon/Mann-Whitney U-test, Fishers exact test, Pearson-Chi-Square test.

Results Total of 5.340 cases, 862 cases < 750g. AUC for VLBW/BW750: CRIB 0.89*/0.77, CRIB-II 0.86*/0.78, PREM 0.86*/0.77 (*p<0.01). For GA22-25 AUC of CRIB/PREM was 0.80/0.70. Lower AUC of all 3 modified scores without BT and/or BE, for instance PREM=0.82 (VLBW) and 0.73 (BW750). AUC of CRIB without influenceable parameters dropped for VLBW from 0.89 to 0.81, for BW750 from 0.77 to 0.66 (compared to modified CRIB-II=0.71, modified PREM=0.73).

Conclusions Standard CRIB is superior to standard CRIB-II, standard PREM, and all score modifications without influenceable items. No difference exists between the 3 scores when omitting influenceable parameters. For ELBW infants < 750g all standard scores are equally predictive, but without influenceable parameters AUC of CRIB is inferior to that of CRIB-II or PREM.

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