Predictive value of different risk scores for mortality and morbidity in extremely preterm infants

Year 2024, Volume: 5 Issue: 2, 95 - 103, 31.05.2024

Gökçe Çıplak , Ülfet Vatansever Özbek , Betül Acunaş

https://doi.org/10.51972/tfsd.1438904

Abstract

ABSTRACT (ENGLISH):
Purpose: To determine the role of different scoring systems in predicting mortality and morbidity risk of preterms who are younger than 32 weeks and/or have a birth weight of less than 1500 g.
Material and Methods: Preterm infants with a gestational age (GA) of less than 32 weeks and/or a birth weight (BW) of less than 1500 grams , who were admitted to the neonatal intensive care unit (NICU) between June 2014 and June 2016, were included in this study. The SNAP-PE-II and CRIB scores in the first 12 hours of life and the NTISS scores at 24, 48, and 72 hours of life were calculated for all newborns. Mortality rate, length of hospital stay, and morbidities were prospectively recorded. The patients were divided into two groups as survivors (Group 1) and non-survivors (Group 2). The data obtained were then statistically compared between the two groups.
Results: A total of 120 preterm infants constituted the study group. There were significant differences between the groups with respect to all studied risk scores (p<0.001). All scores showed satisfactory discrimination and calibration abilities for mortality. As for the morbidities, all of the scores were found to be higher in patients with morbidities than those without, but the situation changed when the ROC analyses were performed and sensitivity and specificity values were calculated.
Conclusion: This is one of the few studies that evaluated the relationship between the scoring systems used to predict mortality risk and common morbidities in extremely preterm patients.
Keywords: scoring systems, CRIB, SNAP-II, SNAP-PE-II, NTISS

Keywords

scoring systems, CRIB, SNAP-II, SNAP-PE-II, NTISS

Ethical Statement

Ethics approval for the study was obtained from the Local Ethics Committee on 15.06.2016, with a protocol number of 12/16 and a protocol code of TUTF-BAEK 2016/160.

Supporting Institution

The authors did not receive support from any organization for the submitted work

Thanks

We would like to thank Prof. Dr. Burcu TOKUÇ for her support in statistical analysis.

References

• Acunaş, B., Uslu, S., Baş, A. Y. (2018). Turkish Neonatal Society guideline for the follow-up of high-risk newborn infants. Turk pediatri arsivi, 53(Suppl 1), S180–S195. https://doi.org/10.5152/TurkPediatriArs.2018.01817
• Asker, H. S., Satar, M., Yıldızdaş, H. Y., et al. (2016). Evaluation of Score for Neonatal Acute Physiology and Perinatal Extension II and Clinical Risk Index for Babies with additional parameters. Pediatrics international : official journal of the Japan Pediatric Society, 58(10), 984–987. https://doi.org/10.1111/ped.12973
• Atasay, B., Günlemez, A., Unal, S., et al. (2003). Outcomes of very low birth weight infants in a newborn tertiary center in Turkey, 1997-2000. The Turkish journal of pediatrics, 45(4), 283–289.
• Brito, A. S., Matsuo, T., Gonzalez, M. R., et al. (2003). Escore CRIB, peso ao nascer e idade gestacional na avaliação do risco de mortalidade neonatal [CRIB score, birth weight and gestational age in neonatal mortality risk evaluation]. Revista de saude publica, 37(5), 597–602. https://doi.org/10.1590/s0034-89102003000500008
• Bruno, C. J., Meerkov, M., Capone, C., et al. (2015). CRIB scores as a tool for assessing risk for the development of pulmonary hypertension in extremely preterm infants with bronchopulmonary dysplasia. American journal of perinatology, 32(11), 1031–1037. https://doi.org/10.1055/s-0035-1547324
• Chawanpaiboon, S., Vogel, J. P., Moller, A. B., et al (2019). Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. The Lancet. Global health, 7(1), e37–e46. https://doi.org/10.1016/S2214-109X(18)30451-0
• Dorling, J. S., Field, D. J., Manktelow, B. (2005). Neonatal disease severity scoring systems. Archives of disease in childhood. Fetal and neonatal edition, 90(1), F11–F16. https://doi.org/10.1136/adc.2003.048488 Erdem G. (2003). Perinatal mortality in Turkey. Paediatric and perinatal epidemiology, 17(1), 17–21. https://doi.org/10.1046/j.1365-3016.2003.00444.x
• Fortes Filho, J. B., Dill, J. C., Ishizaki, A.,et al. (2009). Score for Neonatal Acute Physiology and Perinatal Extension II as a predictor of retinopathy of prematurity: study in 304 very-low-birth-weight preterm infants. Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 223(3), 177–182. https://doi.org/10.1159/000197114
• Gagliardi, L., Cavazza, A., Brunelli, A., et al (2004). Assessing mortality risk in very low birthweight infants: a comparison of CRIB, CRIB-II, and SNAPPE-II. Archives of disease in childhood. Fetal and neonatal edition, 89(5), F419–F422. https://doi.org/10.1136/adc.2003.031286
• Garg, B., Sharma, D., Farahbakhsh, N. (2018). Assessment of sickness severity of illness in neonates: review of various neonatal illness scoring systems. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 31(10), 1373–1380. https://doi.org/10.1080/14767058.2017.1315665
• Gray, J. E., Richardson, D. K., McCormick, M. C., et al. (1992). Neonatal therapeutic intervention scoring system: a therapy-based severity-of-illness index. Pediatrics, 90(4), 561–567.
• Guzmán Cabañas, J. M., Párraga Quiles, M. J., del Prado, N., et al (2009). Análisis de la utilidad del Clinical Risk Index for Babies por estratos de peso como predictor de muerte hospitalaria y de hemorragia intraventricular grave en la Red Neonatal Española SEN 1500 [Usefulness of Clinical Risk Index for Babies based on birth weight in predicting hospital death and severe intraventicular hemorrhage in the SEN 1500 Spanish neonatal network]. Anales de pediatria (Barcelona, Spain : 2003), 71(2), 117–127. https://doi.org/10.1016/j.anpedi.2009.04.007
• Karaarslan U, Bag Ö, Özer EA, et al (2017). Comparison of CRIB-II and SNAP-PE-II Scoring Systems in Predicting the Mortality and Morbidity of Very Low Birth Weight Infants. Türkiye Çocuk Hast Derg. 11(3):183-7 Lee, S. M., Lee, M. H., Chang, Y. S., et al (2019). The Clinical Risk Index for Babies II for Prediction of Time-Dependent Mortality and Short-Term Morbidities in Very Low Birth Weight Infants. Neonatology, 116(3), 244–251. https://doi.org/10.1159/000500270
• Lin, H. J., Ma, X. L., Shi, L. P., et al. (2013). Zhonghua er ke za zhi = Chinese journal of pediatrics, 51(5), 326–330. McLeod, J. S., Menon, A., Matusko, N., et al (2020). Comparing mortality risk models in VLBW and preterm infants: systematic review and meta-analysis. Journal of perinatology : official journal of the California Perinatal Association, 40(5), 695–703. https://doi.org/10.1038/s41372-020-0650-0
• Özcan, B., Kavurt, A. S., Aydemir, Ö., et al. (2017). SNAPPE-II and risk of neonatal morbidities in very low birth weight preterm infants. The Turkish journal of pediatrics, 59(2), 105–112. https://doi.org/10.24953/turkjped.2017.02.001
• Phillips, L. A., Dewhurst, C. J., Yoxall, C. W. (2011). The prognostic value of initial blood lactate concentration measurements in very low birthweight infants and their use in development of a new disease severity scoring system. Archives of disease in childhood. Fetal and neonatal edition, 96(4), F275–F280. https://doi.org/10.1136/adc.2010.185793
• Pollack, M. M., Koch, M. A., Bartel, D. A., et al (2000). A comparison of neonatal mortality risk prediction models in very low birth weight infants. Pediatrics, 105(5), 1051–1057. https://doi.org/10.1542/peds.105.5.1051
• Richardson, D. K., Corcoran, J. D., Escobar, G. J., et al. (2001). SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores. The Journal of pediatrics, 138(1), 92–100. https://doi.org/10.1067/mpd.2001.109608
• Sadeck, L. S., Leone, C. R., Procianoy, R. S., et al. (2014). Effects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus. Jornal de pediatria, 90(6), 616–623. https://doi.org/10.1016/j.jped.2014.04.010
• Sarquis, A. L., Miyaki, M., Cat, M. N. (2002). Aplicação do escore CRIB para avaliar o risco de mortalidade neonatal [The use of CRIB score for predicting neonatal mortality risk]. Jornal de pediatria, 78(3), 225–229.
• Sullivan, B. A., McClure, C., Hicks, J., et al. (2016). Early Heart Rate Characteristics Predict Death and Morbidities in Preterm Infants. The Journal of pediatrics, 174, 57–62. https://doi.org/10.1016/j.jpeds.2016.03.042
• Vardhelli, V., Murki, S., Tandur, B., et al. (2022). Comparison of CRIB-II with SNAPPE-II for predicting survival and morbidities before hospital discharge in neonates with gestation ≤ 32 weeks: a prospective multicentric observational study. European journal of pediatrics, 181(7), 2831–2838. https://doi.org/10.1007/s00431-022-04463-2
• Wu, P. L., Lee, W. T., Lee, P. L., et al (2015). Predictive power of serial neonatal therapeutic intervention scoring system scores for short-term mortality in very-low-birth-weight infants. Pediatrics and neonatology, 56(2), 108–113. https://doi.org/10.1016/j.pedneo.2014.06.005
• Yang, M. B., Donovan, E. F., Wagge, J. R. (2006). Race, gender, and clinical risk index for babies (CRIB) score as predictors of severe retinopathy of prematurity. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 10(3), 253–261. https://doi.org/10.1016/j.jaapos.2006.01.004
• Yoo, H., Lee, J. A., Oh, S., et al. (2017). Comparison of the Mortality and In-Hospital Outcomes of Preterm Infants Treated with Ibuprofen for Patent Ductus Arteriosus with or without Clinical Symptoms Attributable to the Patent Ductus Arteriosus at the Time of Ibuprofen Treatment. Journal of Korean medical science, 32(1), 115–123. https://doi.org/10.3346/jkms.2017.32.1.115
• Zardo, M. S., Procianoy, R. S. (2003). Comparação entre diferentes escores de risco de mortalidade em unidade de tratamento intensivo neonatal [Comparison between different mortality risk scores in a neonatal intensive care unit]. Revista de saude publica, 37(5), 591–596. https://doi.org/10.1590/s0034-89102003000500007
• Zeng, Z., Shi, Z., Li, X. (2023). Comparing different scoring systems for predicting mortality risk in preterm infants: a systematic review and network meta-analysis. Frontiers in pediatrics , 11 , 1287774. https://doi.org/10.3389/fped.2023.1287774