CRIB (CLINICAL RISK INDEX FOR BABIES) IN RELATION TO NOSOCOMIAL BACTEREMIA IN VERY-LOW-BIRTH-WEIGHT OR PRETERM INFANTS

Positive blood cultures in very low birthweight or preterm infants usu ally reflect bacteraemia, septicaemia, or failure of asepsis during sa mpling and lead to increased costs and length of stay. Rates of nosoco mial, or hospital acquired, bacteraemia may therefore be important ind icators of neonatal unit performance, if comparisons are adjusted for differences in initial risk. In a preliminary study the risk of nosoco mial bacteraemia was related to initial clinical risk and illness seve rity measured by the clinical risk index for babies (CRIB). Nosocomial bacteraemia was defined as clinically suspected infection with cultur e of bacteria in blood more than 48 hours after birth. One or more epi sodes of noscomoial bacteraemia were identified retrospectively in 36 of 143 (25%) infants in a regional neonatal unit between 1992 and 1994 . Biologically plausible models were developed using regression analys is techniques. After correcting for period at risk, nosocimial bactera emia was independently associated with gestation at birth and CRIB. De ath was independently associated with CRIB, but not with noscomial bac teraemia. CRIB may contribute, with other explanatory variables, to mo re comprehensive predictive models of death and nosocomial infection. These may facilitate future risk adjusted comparative studies between groups of neonatal units.