PREDICTING OUTCOME IN VERY-LOW-BIRTH-WEIGHT INFANTS USING AN OBJECTIVE-MEASURE OF ILLNESS SEVERITY AND CRANIAL ULTRASOUND SCANNING

Aim-To investigate the feasibility of developing an objective tool for predicting death and severe disability using routinely available data , including an objective measure of illness severity, in very low birt hweight babies. Method-A cohort study of 297 premature babies survivin g the first three days of life was made. Predictive variables consider ed included birthweight, gestation, 3 day cranial ultrasound appearanc es and 3 day CRIB (clinical risk index for babies) score. Models were developed using regression techniques and positive predictive values ( PPV) and likelihood ratios (LR) were calculated. Results-On univariate analysis, birthweight, gestation, 3 day CRIB score and 3 day cranial ultrasound appearances were each associated with death. On multivariat e analysis, 3 day CRIB score and 3 day cranial ultrasound appearances remained independently associated. A 3 day CRIB score > 4 along with i ntraventricular haemorrhage (IVH) grade 3 or 4 was associated with a P PV of 64% and an LR of 9.8 (95% confidence Limits 3.5, 27.9). Only 3 d ay CRIB score and 3 day cranial ultrasound appearances were associated with severe disability on univariate analysis. Both remained independ ently associated on multivariate analysis. A 3 day CRIB score > 4 alon g with an IVH grade of 3 or 4 was associated with a PPV of 60% and an LR of 24.2 (95% CI 4.4, 133.3). Conclusion-Incorporating objective mea sures of illness severity may improve current prediction of death and disability in premature infants.