Clinical risk index for babies (Crib) ii score as a predictor of neonatal mortality among low birth weight babies at Kenyatta National Hospital

Abstract

Background: Neonatal deaths, especially among the Low Birth Weight (LBW) babies, are of major concern in the Newborn Unit (NBU) of Kenyatta National Hospital (KNH). Several instruments have been developed to predict initial mortality risk among the LBW babies. Among them is the scoring system Clinical Risk Index for Babies also known as CRIB II score. Objective: To evaluate the use of CRIB II score as a tool to predict the risk for neonatal mortality among the LBW babies at KNH. Design: A prospective cohort study. Setting: Newborn Unit of Kenyatta National Hospital. Subject: A total sample of 135 low birth weight babies were followed up from admission till discharge, the 28th day of life or death whichever came first. Results: One hundred and thirty five newborns were enrolled into the study. Birth weight ranged from 600 – 2500g, with a median of 1600g. Total CRIB II score ranged from 1 – 15, with a median of 5.5. Gestational age ranged from 26 – 38 weeks. Total mortality was 45.9%. Birth weight <1500g, gestational age <30 weeks, base excess <-12mmol/l, temperature at admission >37.5 or <35 (all components of CRIB II) and total CRIB II score of > 4 were all found to be significantly associated with hospital neonatal mortality. Using a cut off point of 4, CRIB II score was found to have a sensitivity of 80.6%, specificity of 75.3%, and a predictive value of 77.7% compared to 72.5, 71.2, and 71.8% respectively for birthweight. Gestational age was found to have even lower figures; 56, 75 and 66% for sensitivity, specificity and predictive values respectively. Conclusion: CRIB II score of > 4 was found to have better prediction for mortality among the LBW babies at KNH-NBU compared to the traditionally used predictors and can be used to prioritise care for such neonates for better outcome.