ILLNESS SEVERITY MEASURED BY CRIB SCORE - A PRODUCT OF CHANGES IN PERINATAL-CARE

Aim-To determine the perinatal factors associated with initial illness severity (measured by the CRIB (clinical risk index for babies) score ) and its relation to survival to discharge. Methods-A retrospective s tudy was made of intensive care nursing records on 380 inborn babies, of less than 31 weeks gestation or 1501 g birthweight, admitted to one unit between 1984-6 and 1991-4. Results-Between the two time periods mean initial illness severity score increased significantly from 2.8 t o 3.9. This was the result of an increase in the maximum appropriate i nspired oxygen concentration in the first 12 hours. Risk adjusted surv ival did not improve over time after accounting for gestation but was significantly greater after accounting for CRIB score. Illness severit y score was also significantly inversely associated with gestation and 1 and 5 minute apgar scores, using multiple regression analysis. Betw een the two time periods there was also a 92% increase in the admissio n rate of babies under 31 weeks gestation, higher median 1 and 5 minut e Apgar scores (6 vs 5 and 9 vs 8, respectively), more multiple births , and more caesarean section deliveries. Conclusions-The increase in i llness severity score and admission Rate may reflect changes in obstet ric practice. The increase in illness severity score may also reflect changes in early neonatal care. However, after adjusting for CRIB scor e, risk adjusted mortality fell significantly, suggesting that neonata l care 12 hours from birth onwards had improved with time.