European Journal of Cardiovascular Medicine

Worldwide, neonatal mortality continues to be a major cause of newborn fatalities, especially in poorer nations. Prematurity and low birth weight are the main causes of newborn fatalities, which make up around 45% of under-five mortality, according to the World Health Organisation (WHO, 2022)¹². Advances in newborn care have improved the survival of VLBW infants (less than 1500 g), yet the death rate is still significant. There is little information available about newborn outcomes from traditional indicators such birth weight and gestational age. Therefore, especially in situations with limited resources, composite scoring systems, such the CRIB score, have been created to predict newborn mortality by integrating birth weight, gestational age, congenital abnormalities, and physiological indicators in the first 12 hours of life.

The CRIB score has been shown in several studies to be a valid indicator of newborn death and morbidity. For example, a research by Richardson et al. (1993)¹ showed that infant mortality and CRIB scores were strongly correlated, with higher scores suggesting a larger chance of unfavourable outcomes. De Courcy-Wheeler et al. (1995)² verified the CRIB score in NICU conditions in a comparable research, highlighting its prognostic advantage over gestational age and birth weight alone. These results have been confirmed by more recent research, which makes CRIB a crucial instrument for evaluating newborn risk.

In 1993, the CRIB score was developed as a means of evaluating the degree of sickness in newborns admitted to intensive care units. Numerous investigations supported it, such as one by de Courcy-Wheeler et al. (1995)², which showed that CRIB scores were a better predictor of newborn death than birth weight alone. The accuracy of CRIB ratings in forecasting infant death and morbidity in a tertiary NICU environment has been validated by further studies. In addition to comparing NICU performance, this study aims to improve risk stratification techniques for VLBW babies by examining the relationship between CRIB scores and important newborn problems. (Gagliardi et al., 2004)³.

The CRIB score's early applicability, which enables physicians to evaluate mortality risk within the first 12 hours of birth, is one of its main advantages. The CRIB score provides a quicker evaluation than other newborn severity ratings, such as SNAP (Score for newborn Acute Physiology), which necessitates a 24-hour observation period. This makes it possible to allocate resources and conduct therapeutic treatments for high-risk newborns early.

CRIB scores have been connected to newborn morbidity and death prediction. Research has indicated a noteworthy association between elevated CRIB scores and ailments including sepsis, respiratory distress syndrome, necrotising enterocolitis, and intraventricular haemorrhage (IVH). Sarquis et al. (2016)⁷, for example, found that newborns with CRIB scores more than 10 were far more likely to experience serious problems than those with lower scores.

The CRIB score has certain drawbacks despite its advantages. It excludes postnatal treatments like mechanical ventilation as well as clinical deterioration beyond the first 12 hours of birth. Furthermore, research on its suitability for extremely preterm infants (less than 24 weeks gestation) is also continuing. Nonetheless, it is still a commonly used method for clinical research and newborn risk assessment.

The purpose of this study is to assess how well CRIB ratings predict infant death and morbidity in a tertiary intensive care unit. This study aims to improve risk classification techniques for VLBW newborns by examining the relationship between CRIB scores and important neonatal problems. By enabling early treatments and maximising NICU resource utilisation, an understanding of the predictive ability of CRIB scores would contribute to better newborn outcomes.

Study Design

A longitudinal observational study was conducted in the NICU of a tertiary care hospital over two years.

Study Population

• Inclusion criteria: VLBW neonates (<1500 g) admitted within 12 hours of birth.
• Exclusion criteria: Neonates with lethal congenital anomalies, those who died within 12 hours, and those older than 7 days at admission.

Data Collection and CRIB Score Calculation

• Birth weight, gestational age, congenital malformations, and physiological parameters (oxygen requirement and base excess) were recorded within 12 hours of admission.
• Neonates were categorized into four groups based on CRIB scores: 0-5, 6-10, 11-15, and >15.

Statistical Analysis

• Mortality and morbidity parameters (IVH, RDS, NEC, and sepsis) were analyzed.
• Binary logistic regression and ROC curve analysis were performed.

Table : CRIB (CLINICAL RISK INDEX FOR BABIES ) Score

Table 1: CRIB Score Distribution and Mortality Rates

Figure 1

Table 2: Morbidity Parameters by CRIB Score

Figure 2

Table 3: Association Between CRIB Score and Length of Hospital Stay

Figure 3

Table 4: Association Between CRIB Score and Intraventricular Hemorrhage (IVH) Severity

Figure 4

Table 5: CRIB Score and Neonatal Sepsis Incidence

Figure 5

The study's results support the CRIB score's usefulness in forecasting newborn death and morbidity in VLBW babies. greater CRIB scores are strongly associated with greater mortality, which is consistent with other research (Richardson et al., 1993; de Courcy-Wheeler et al., 1995).^1,2 Our data support previous findings that the severity of disease at delivery is a substantial predictor of survival (Gagliardi et al., 2004)³ by showing that newborns with CRIB scores over 15 had an 85.7% death rate.³

Additionally, there was a strong correlation between CRIB scores and morbidity outcomes, such as sepsis, IVH, RDS, and NEC. The findings of Rivas Ruiz et al. (2012)⁴ are supported by the gradual rise in IVH severity with increasing CRIB scores, which implies that critically unwell newborns are more likely to experience brain haemorrhages. Similarly, the findings of Sarquis et al. (2016)⁷, who showed that critically sick newborns need greater respiratory assistance and are more likely to experience pulmonary problems, are in line with the observed correlation between higher CRIB scores and an increased incidence of RDS.

With over half of the newborns in the 11-15 CRIB group having sepsis, neonatal sepsis—another leading cause of neonatal morbidity and mortality—was substantially correlated with CRIB scores. This corroborates the findings of the Breuel et al. (2017)⁸ study, which showed that infants with higher CRIB scores were more susceptible to infections due to a weakened immune system. Furthermore, the strong correlation between CRIB scores and NEC supports earlier research (Yang et al., 2018)⁹, emphasising the part that ischaemia and systemic inflammation play in the aetiology of NEC.

Even while some newborns with lower CRIB scores needed longer hospital stays, there was a modest correlation between hospital stay duration and CRIB scores. The CRIB score does not account for difficulties that develop beyond the first 12 hours of life, which might be the cause of this variance (Vakrilova et al., 2019)¹⁰. These results highlight the necessity of ongoing clinical surveillance after the early neonatal period, even if CRIB is still a valuable prognostic tool.

The prospective design and standardised use of CRIB ratings are two of this study's many strong points. Its drawbacks, however, include a small sample size and a single-center design, which may restrict generalisability. It is advised that further multi-center research with bigger cohorts confirm these results.

The importance of the CRIB score in forecasting death and morbidity in very low birth weight (VLBW) newborns is demonstrated by this study. In addition to problems including sepsis, respiratory distress syndrome, necrotising enterocolitis, and intraventricular haemorrhage (IVH), the data show a substantial correlation between higher CRIB scores and greater mortality. In neonatal intensive care units (NICUs), these results confirm the CRIB score's validity as a trustworthy early prognostic tool. Its clinical relevance is highlighted by the discovery of a CRIB score threshold (>4) with good predictive accuracy (AUC = 0.87). This cutoff point can help medical professionals identify high-risk newborns early and take prompt action to increase survival rates. The CRIB score has predictive significance, however it ignores postnatal therapies and illness development after the first 12 hours. For a more thorough evaluation of newborn outcomes, future studies should investigate combining CRIB with other grading systems. To sum up, the CRIB score is still a useful instrument for evaluating newborn risk. It is a crucial part of NICU procedures because of its ease of use and potent predictive power, which help with focused therapies and raise infant survival rates.

 
LIMITATIONS OF STUDY

• Single-center study limits generalizability.
• Small sample size restricts broader applicability.
• Lack of long-term follow-up for neurodevelopmental outcomes.

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