OBJETIVO: Analisar os efeitos da terapêutica adotada para o canal arterial (CA) em recém-nascidos (RN) < 1.000gadmitidos em unidades neonatais (UN) da Rede Brasileira de Pesquisas Neonatais (RBPN), sobre os desfechos: óbito, displasia broncopulmonar (DBP), hemorragia intraventricular grave (HIVIII/IV), retinopatia da prematuridade cirúrgica (ROPcir), enterocolite necrosante cirúrgica (ECNcir) e o desfecho combinado óbito e DBP. MÉTODOS: Estudo multicêntrico, de coorte, coleta de dados retrospectiva, incluindo RN de 16 UN da RBPN de 01/01/2010 a 31/12/2011, PN < 1.000 g, idade gestacional (IG) < 33 semanas e diagnóstico ecocardiográfico de PCA. Excluídos: óbitos ou transferências até o terceiro dia de vida, infecções congênitas ou malformações. Grupos:G1 - conservadora (sem intervenção medicamentosa ou cirúrgica), G2 - farmacológica (indometacina ou ibuprofeno) e G3 - cirúrgico (com ou sem tratamento farmacológico anterior). Analisou-se: uso de esteroide antenatal, parto cesárea, PN, IG, Apgar5' < 4, sexo masculino, SNAPPE II, síndrome do dDesconforto respiratório (SDR), sepse tardia, ventilação mecânica (VM), surfactante < 2 horas de vida, tempo de VM e os desfechos: óbito, dependência de oxigênio com 36 semanas (DBP36s), HIV III/IV, ROPcir, ECNcir e óbito/DBP36s. Estatística: Teste t-Student, Qui-Quadrado ou teste Exato de Fisher. Testes de Regressão Binária Logística e Regressão Múltipla Stepwise Backward. MedCalc (Medical Calculator) software, versão 12.1.4.0.p < 0,05. RESULTADOS: Foram selecionados 1.097 RN e 494 foram incluídos: G1-187 (37,8%), G2-205 (41,5%) e G3-102 (20,6%). Verificou-se: maior mortalidade (51,3%) no G1 e menor no G3(14,7%); maior frequência DBP36s (70,6%) e ROPcir (23,5%) no G3; maior frequência de óbito/DBP36s no G2 (58,0%). As abordagens farmacológica (OR-0,29; 95%, IC-0,14-0,62) e conservadora (OR-0,34; 95%, IC- 0,14-0,79) foram protetoras somente para o desfecho óbito/DBP36sem. CONCLUSÃO: Em RN com PCA, a abordagem conservadora relacionou-se à maior mortalidade, a cirúrgica à ocorrência de DBP36s e ROPcir., enquanto o tratamento farmacológico mostrou-se protetor para o desfecho óbito/DBP36sem.

OBJECTIVE: To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g) with patent ductus arteriosus (PDA), from the Brazilian Neonatal Research Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizing enterocolitis requiring surgery (NECsur), and death/BPD. METHODS: This was a multicentric cohort study, retrospective data collection, including newborns (BW < 1000 g) with gestational age (GA) < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: G1 - conservative approach (without treatment), G2 - pharmacologic (indomethacin or ibuprofen), G3 - surgical ligation (independent of previous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfactant (< 2 h of life), and time of MV. Outcomes: death, O2 dependence at 36 weeks (BPD36wks), IVH III/IV, ROPsur, NECsur, and death/BPD36wks. Statistics: Student's t-test, chi-squared test, or Fisher's exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p-values < 0.05 were considered statistically significant. RESULTS: 1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%), G2 - 205 (41.5%), and G3 - 102 (20.6%). The highest mortality was observed in G1 (51.3%) and the lowest in G3 (14.7%). The highest frequencies of BPD36wks (70.6%) and ROPsur were observed in G3 (23.5%). The lowest occurrence of death/BPD36wks occurred in G2 (58.0%). Pharmacological (OR 0.29; 95% CI: 0.14-0.62) and conservative (OR 0.34; 95% CI: 0.14-0.79) treatments were protective for the outcome death/BPD36wks. CONCLUSION: The conservative approach of PDA was associated to high mortality, the surgical approach to the occurrence of BPD36wks and ROPsur, and the pharmacological treatment was protective for the outcome death/BPD36wks.

OBJECTIVES:The assessment of early sucking by preterm infants provides information on the ability of these infants to efficiently and safely receive nutrients via an oral route (oral feeding). To analyze the application and reliability of an instrument in assessing non-nutritive sucking that indicates a capacity for oral feeding in the routine care of different neonatal units.METHODS:A multicenter, prospective cohort study was conducted in seven neonatal units. A non-nutritive sucking assessment with a formulary validated by Neiva et al (2008) (variables evaluated: rooting reaction; easy initiation of sucking; labial sealing; tongue central groove; peristaltic tongue movements; jaw raising and lowering movements; labial, tongue and jaw coordination; sucking strength; sucking rhythm; bites; excessive jaw excursion; stress signals) was applied to 199 pre-term newborns, who had a chronological age ≥ 2 days and were clinically stable. These infants were divided into two groups based on their corrected gestational age at the first assessment, as follows: Group I-infants with a gestational age ≤ 33 weeks and Group II-infants with a gestational age between 34 and 36 6/7 weeks.RESULTS:The mean gestational age was 31.66±2 weeks, and the mean birth weight was 1494 ± 373 g. The mean scores on the non-nutritive sucking assessment were 46 ± 25 in Group I and 49 ± 24 in Group II. The beginning of oral feeding was successful in 43 (67.2%) infants in Group I and 64 (81%) infants in Group II (p= 0.089).CONCLUSION:The method identified preterm infants who were able to feed orally based on 33 points in the non-nutritive sucking assessment and a corrected gestational age of 32 weeks or more. The corrected gestational age was the most important factor in predicting the success of oral feeding.

OBJETIVOS: Este modelo experimental foi desenvolvido para analisar os efeitos da restrição nutricional e da hiperoxia, durante 11 dias, sobre o peso e a morfometria pulmonares, em coelhos prematuros. MÉTODOS: Após cesárea, coelhos New Zealand White com idade gestacional de 28 dias foram randomizados nos seguintes grupos: dieta controle e ar ambiente, dieta controle e hiperoxia (> 95% O2), restrição nutricional e ar ambiente e restrição nutricional e hiperoxia (>95% O2). A restrição nutricional foi obtida com uma redução em 30% de todos os nutrientes da dieta controle. As lâminas de pulmão foram coradas com hematoxilina-eosina, resorcina-orceína modificada e picrosírius, sendo posteriormente realizada a análise morfométrica RESULTADOS: Observou-se um menor ganho de peso no grupo restrição nutricional e hiperoxia (p < 0,001) a partir do quarto dia e, no grupo restrição nutricional e ar ambiente (p < 0,001), a partir do sexto dia de vida, em relação aos respectivos grupos controles. A restrição nutricional reduziu o número de alvéolos (p < 0,001) e o depósito de colágeno (p < 0,001). A hiperoxia produziu uma redução do número de alvéolos (p < 0,001) e do depósito de colágeno (p < 0,001), além de maiores intercepto linear médio (p < 0,05) e espessamento de septos inter-alveolares (p < 0,001). A restrição nutricional associada à hiperoxia intensificou a redução do número de alvéolos (p < 0,001) e do depósito de colágeno (p < 0,001). CONCLUSÕES: A restrição nutricional intensificou as alterações morfométricas pulmonares produzidas pela hiperoxia, especialmente em relação à alveolização e depósito de colágeno.

OBJECTIVES: To analyze the effects of nutritional restriction and hyperoxia on lung weight and pulmonary morphometry in premature rabbits during the first 11 days of life METHODS: New Zealand White rabbits were delivered by C-section at 28 days' gestational age and randomized into four groups: control diet and room air, control diet and hyperoxia (> 95% O2), nutritional restriction and room air and nutritional restriction and hyperoxia (> 95% O2). Nutritional restriction was achieved by reducing all nutrients by 30% in comparison with the control diet. Lung tissue slides were stained with hematoxylin-eosin, modified resorcin-orcein and picrosirius, before morphometric analysis was performed. RESULTS: From the fourth day onwards, less weight was gained by the nutritional restriction and hyperoxia group (p < 0.001) and from the sixth day on, by the nutritional restriction and room air group (p < 0.001), in comparison with their respective control groups. Nutritional restriction decreased alveoli number (p < 0.001) and collagen deposition (p < 0.001). Hyperoxia was responsible for reductions in number of alveoli (p < 0.001) and collagen deposition (p < 0.001), in addition to higher mean linear intercept values (p < 0.05) and thickening of alveolar septa (p < 0.001). When nutritional restriction was associated with hyperoxia, the reductions in number of alveoli (p < 0.001) and of collagen deposition (p < 0.001) intensified. CONCLUSIONS: Nutritional restriction intensified the changes of pulmonary architecture findings caused by hyperoxia, in particular through alterations to alveolarization and collagen deposition.

Devido às suas ações anti-inflamatórias, os corticosteróides têm sido utilizados para prevenção de displasia broncopulmonar, sendo descrita, uma redução da incidência desta patologia. No entanto, efeitos adversos a curto e a longo prazo têm sido detectados, em recém-nascidos pré-termo. OBJETIVO: Analisar os efeitos sobre a incidência de displasia broncopulmonar, duração de ventilação mecânica e de internação, mortalidade, crescimento, além dos efeitos adversos dos corticosteróides, administrados entre 10-14 dias de vida, em recém-nascidos de muito baixo peso, dependentes de ventilação mecânica. MÉTODOS: Realizou-se estudo de coorte, incluindo-se todos os recém-nascidos com peso de nascimento < 1500 gramas dependentes de ventilação mecânica, entre 10-14 dias de vida. Foram divididos em: Grupo I - receberam dexametasona (16) e Grupo II - não receberam dexametasona (22). Administrou-se dexametasona, a partir do 10º dia de vida, dias 1 a 3 - 0,3 mg/kg/d, dias 4 a 6 - 0,2 mg/kg/d, dias 7 a 9 - 0,1 mg/kg/d. Analisou-se o desenvolvimento de displasia broncopulmonar (dependência de oxigênio aos 28 dias de vida), efeitos sobre a evolução respiratória e sobre o padrão de crescimento, além da ocorrência de efeitos adversos. RESULTADOS: A incidência de displasia broncopulmonar não diferiu entre os grupos (GI - 62,5%; GII - 22,7%;p = 0,07). Detectou-se desaceleração do crescimento no GI em relação ao GII(D P = 47g/semana, GI e 85,5g/semana, GII; p = 0,06; D PC - 0,75 cm/semana GI e 1cm/semana, no GII; p = 0,05). CONCLUSÃO: O uso de corticosteróides, em recém-nascidos pré-termo, entre 10 - 14 dias de vida não reduziu incidência de displasia broncopulmonar e causou uma desaceleração do crescimento.

Corticosteroids have been used in bronchopulmonary dysplasia prevention because of their antiinflammatory effects. Among their effects is a decrease in the incidence of bronchopulmonary dysplasia. However, short- and long-term side effects have been detected in preterm newborns. PURPOSE: To analyze the effects of corticosteroids on bronchopulmonary dysplasia, length of stay, mortality, growth, as well as the adverse effects in very low birth weight newborns between 10 and 14 days of life and dependent on mechanical ventilation. METHODS: Cohort study. All newborns with a birth weight under 1500 g, mechanical ventilation-dependent between 10 and 14 days of life, during the period January 2000 and June 2001 were included (n = 38). They were divided into 2 groups: Group I with corticosteroids (n = 16) and Group II without corticosteroids (n = 22). Dexamethasone administration: from the 10th day of life, d1 - d3, 0.3 mg/kg/d; d4 - d6, 0.2 mg/kg/d; d7 - d9, 0.1 mg/kg/d. Respiratory evolution, bronchopulmonary dysplasia (oxygen dependence at 28 days of life), growth pattern and the presence of adverse effects were analyzed. RESULTS: The incidence of bronchopulmonary dysplasia was 6.5% (Group I) and 30% (Group II), P = .07. A decrease in growth was detected in Group I compared with Group II (change in weight: Group I - 47 g/week, Group II - 85.5 g/week, P = .06; change in head circumference: Group I - 0.75 cm/week, Group II - 1 cm/week, P = .05). CONCLUSION: Use of corticosteroids in very low birth weight infants dependent on mechanical ventilation during the first 10 to 14 days of life did not affect the respiratory evolution and occurrence of bronchopulmonary dysplasia, but the velocity of growth was reduced.

OBJETIVO: Estudar a relação entre a qualidade, tipos e trajetória dos movimentos generalizados espontâneos em recém-nascidos pré-termo com os achados da ultra-sonografia de crânio neonatal e com a evolução neurológica. MÉTODO: 40 recém-nascidos pré-termo, com idade gestacional < 35 semanas, tiveram seus movimentos generalizados registrados através de videoteipe durante os períodos pré-termo, a termo (37ª - 42ª semana de idade pós-concepcional) e pós-termo (49ª - 56ª semana de idade pós-concepcional), e foram seguidos prospectivamente até um ano de idade pós-concepcional. RESULTADOS: Nossos resultados mostraram que a qualidade dos movimentos generalizados, particularmente no período pós-termo (p = 0,009), foram relacionados com a presença de lesões cerebrais detectadas à ultra-sonografia e com a evolução neurológica. Enquanto a presença de lesões ultra-sonográficas graves foi associada à evolução neurológica desfavorável (p = 0,01), o achado de padrões de movimentos generalizados espontâneos normais foi associado à normalidade neurológica no seguimento, com valores preditivos negativos de 100%, para o período pré-termo, e 80% para ambos os períodos a termo e pós-termo. CONCLUSÕES: Quando usados conjuntamente, esses métodos podem aumentar a especificidade e a sensibilidade na detecção de um grupo de recém-nascidos pré-termo de alto risco para seqüelas neurológicas, no seguimento a longo prazo.

OBJECTIVE: To study the relationship among the quality, type, and trajectory of general movements in preterm infants and neonatal cranial ultrasonography findings and neurological outcome. METHOD: Forty preterm newborn infants, with gestational ages under 35 weeks, had their general movements recorded through video-tape during the preterm, term (37th - 42nd postconceptional weeks of age) and post-term (49th - 56th postconceptional weeks of age) periods, and were prospectively followed up to one-year conceptional age. RESULTS: Our results showed that the quality of general movements, particularly in the post-term period (p = 0.009), were related with the presence of severe cerebral lesions in the neonatal cranial ultrasonography and the neurological outcome. While the presence of severe ultrasonography lesions was associated with an adverse neurological outcome (p = 0.01), the finding of normal general movements patterns was associated with a normal neurological outcome, with negative predictive values of 100%, for the preterm, and 80%, for both term and post-term periods. CONCLUSIONS: When concurrently used, these evaluation methods may increase the specificity and sensitivity in detecting the group of preterm infants at high-risk for neurological disturbances in long-term follow-up.

OBJETIVOS: avaliar o uso de corticosteróide antenatal (CA) nas mães e as suas repercussões nas condições de nascimento das crianças nascidas pré-termo nas oito unidades neonatais universitárias da Rede Brasileira de Pesquisas Neonatais. MÉTODOS: estudo observacional do tipo coorte prospectivo. Foram avaliadas 463 gestantes com idade gestacional (IG) entre 23 e 34 semanas e seus 514 recém-nascidos no período de 1 de agosto a 31 de dezembro de 2001. Os dados foram obtidos por entrevista materna, análise de prontuário e acompanhamento dos recém-nascidos, e analisados pelos testes do chi2, Mann-Whitney, ANOVA e regressão logística múltipla, com nível de significância de 0,05. RESULTADOS: 60,1% (282/463) das gestantes (variação de 12,5 a 87,3% entre as unidades) receberam ao menos uma dose de CA. A freqüência do uso de CA foi diretamente associada ao número de consultas de pré-natal, hipertensão materna e uso antenatal de tocolíticos. Quando as gestantes foram tratadas, os RN apresentaram maior peso de nascimento (1379±421 vs 1244±543 g), idade gestacional mais avançada (30,9±2,0 vs 29,5±3,5 semanas), melhores valores do escore de Apgar no 1º e 5º minuto e menor freqüência de intervenção na sala de parto. O uso de CA, a IG e o fato de ser pequeno para a IG melhoraram, de forma independente, as condições de nascimento. CONCLUSÕES: o uso de CA, na maioria dos centros, foi feito em freqüência abaixo da desejada e em metade das vezes de forma inadequada. O tratamento foi mais aplicado a mães com melhor acompanhamento durante o pré-natal e foi associado com melhores condições de nascimento.

PURPOSE: to assess the use of antenatal corticosteroid (AC) by mothers and its repercussion on the birth conditions of preterm babies at the eight university neonatal units belonging to the Brazilian Network of Neonatal Research. METHODS: an observational prospective cohort study. All 463 pregnant women with a gestational age (GA) of 23 to 34 weeks and their 514 newborn babies were evaluated during the period from August 1 to December 31, 2001. The data were obtained by maternal interview, by the analysis of the medical records and by the follow-up of the newborn infants, and analyzed statistically using chi2, Mann-Whitney and ANOVA tests and multiple logistic regression, with the level of significance set at 0.05. RESULTS: 60.1% (282/463) of the pregnant women (a variation from 12.5 to 87.3% among units) received at least one AC dose. The AC use was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented higher birth weight (1,379±421 vs 1,244±543 g), longer gestational age (30.9±2.0 vs 29.5±3.5 weeks), better Apgar scores at the 1st and 5th minute, and a reduced need for intervention in the delivery room. The use of AC, the GA and a baby small for GA independently improved the birth conditions. CONCLUSIONS: at most centers, AC was administered at frequencies below the desired ones, and in 50% of cases in an inadequate manner. Treatment was applied more to mothers who received appropriate prenatal care and was associated with better birth conditions.

OBJETIVO: Avaliar o comportamento da glicemia em recém-nascidos (RN) de mães hipertensas conforme o tratamento materno. MÉTODOS: Estudo prospectivo, randomizado, incluindo 93 RN de mães tratadas com isradipina(n=39), atenolol (n=40) ou dieta - controle (n=14). Determinou-se a glicemia ao nascimento (mãe e RN, pela glicose oxidase) e na 1ª., 3ª., 6ª., 12ª. e 24ª. horas (RN, por fita reagente). A evolução da glicemia, em cada grupo, foi analisada (Teste de Friedman). Os grupos foram comparados, quanto às glicemias, em cada momento (Teste de Kruskall-Wallis) e foram ajustados modelos de regressão linear para as glicemias (variável independente = glicemia materna; variáveis dependentes = glicemias de cordão, 3ª. e 6ª. horas). RESULTADOS: Não houve diferença estatisticamente significante entre as glicemias médias dos 3 grupos, em qualquer uma das coletas. Houve correlação entre as glicemias materna e de cordão umbilical nos grupos isradipina (r =0,61; p<0,05) e controle (r =0,84; p<0,05); entre as glicemias materna e 3ª. e 6ª. horas, houve apenas no grupo controle (materna X 3ª.hora: r = 0,65; p<0,05; materna X 6a.hora: r =0,68; p<0,05). Não houve correlação em nenhum momento no grupo atenolol. Detectou-se hipoglicemia em 51,3% (Isradipina), 60% (Atenolol) e 35,7% (Controle), mais freqüentemente na 1ª. hora de vida, em todos os grupos. CONCLUSÕES: Os resultados sugerem efeito semelhante dos 3 tipos de terapêutica sobre a glicemia do RN. As análises de correlação sugerem que a isradipina possa ter efeitos sobre a glicemia somente após o nascimento (correlação apenas em cordão umbilical), enquanto o atenolol, possa atuar mais precocemente (não se correlacionou em nenhum momento). Também reforçam a necessidade de controle glicêmico desde a 1ª. hora de vida em RN de mães hipertensas, submetidas ou não a tratamento medicamentoso.

PURPOSE: To evaluate the evolution of glycemic levels in newborns of hypertensive mothers according to maternal treatment. METHODS: Prospective randomized study, including 93 newborns of mothers treated with isradipine (n = 39), atenolol (n = 40), or low sodium diet (control group - n=14). Glycemia was determined at birth (mother and newborn by the oxidase glucose method) and in the 1st, 3rd, 6th, 12th, and 24th hours after birth (newborn by a test strip method). The evolution of glycemia was analyzed in each group (Friedman test). The groups were compared regarding glycemia (Kruskall-Wallis test), and linear regression models were constructed for the analyses (independent variable = maternal glycemia; dependent variables = umbilical cord, 3rd, and 6th hour glycemia). RESULTS: There were no statistically significant differences among the mean blood glucose levels of the 3 groups in any of the assessments. There was a correlation between maternal and umbilical cord blood glucose in the isradipine (r = 0.61; P <.05) and control (r = 0.84; P <.05) groups. Regarding glycemia levels of the mothers and newborns in the third and sixthhours postpartum, this correlation was present only in the control group (maternal x third hour: r = 0.65; P <.05; maternal x sixth hour: r = 0.68; P <.05). There were no correlations in the atenolol group. Hypoglycemia was detected in 51.3% of the isradipine group, 60% of the atenolol group, and 35.7% of the control group, and it was more frequent in the first hour postpartum in all groups. CONCLUSIONS: The results suggest a similar effect of the 3 types of treatment upon newborn glycemia. The correlation analysis suggests that isradipine could have effects upon newborn glycemia only after birth (correlation only in umbilical cord blood), whereas atenolol could act earlier (there was no correlation at any moment). The results also point to the need for glycemic control from the first hour postpartum of newborns of hypertensive mothers whether they have or have not undergone treatment with antihypertensive drugs.

OBJETIVO: Comparar o valor preditivo do CRIB (Clinical Risk Index for Babies) para o risco de mortalidade neonatal ao peso de nascimento (PN) e idade gestacional (IG). MÉTODO: Numa coorte prospectiva foram estudados, durante o ano de 1996, 71 recém-nascidos admitidos na unidade de terapia intensiva, com PN < 1.500 g e/ou IG < 31 semanas. RESULTADOS: A taxa de mortalidade foi de 29,6%; para PN < 1.000 g ou IG < 29 semanas foi de 60%, enquanto que para o escore de CRIB > 10 foi de 100%. CONCLUSÕES: O escore de CRIB > 10 correspondeu a maiores especificidade e valor preditivo positivo em relação aos demais parâmetros. A área determinada pela "receiver operating characteristic" relativa ao CRIB também foi superior. O CRIB mostrou-se um marcador mais acurado na previsão de risco de mortalidade quando comparado ao PN ou IG isoladamente.

OBJECTIVE: Several indicators, mainly birthweight and gestational age, have been used to predict the mortality risk in neonatal intensive care units. In order to assess the potential value of CRIB in predicting neonatal mortality, the score was used over the first 12 hours of life of the newborns admitted to this unit, during the year of 1996. METHOD: The inclusion criteria consisted of all infants without inevitably lethal congenital malformations, birthweight below 1,500g and/or gestational age less than 31 weeks. Newborn children who died within 12 hours after delivery were excluded. The CRIB score covers birth weight, gestational age, the presence of congenital malformations (not inevitably lethal ) and three indexes of physiological status during first 12 hours after birth - maximum and minimum appropriate fraction of inspired oxygen and maximum (most acidotic) base excess. RESULTS: In a prospective cohort, seventy one newborn children were studied. The birthweight (average) was 1,119 ± 275.6 g, gestational age 30 weeks 4/7 ±2 weeks 3/7; male (57%); Apgar 1° min. score <=3 ( 36.2%) and Apgar 5° min. score < 5 (5.8%). The mortality rate was 29.6% (gold standard). But mortality rate by birthweight less than 1,000 gr. or gestational age lower than 29 weeks was 60.0% and for the CRIB score above 10 was 100%. DISCUSSION: The specificity and predictive positive values for CRIB score above 10 were greater than any other two parameters. The area under the receiver operating characteristic (ROC) curve for predicting death was significantly greater for CRIB than for birthweight alone. It was concluded that the CRIB score is a better predictive indicator for mortality than are birthweight and gestational age.

OBJETIVO: Comparar o valor preditivo do CRIB (Clinical Risk Index for Babies) para o risco de mortalidade neonatal ao peso de nascimento (PN) e idade gestacional (IG). MÉTODO: Numa coorte prospectiva foram estudados, durante o ano de 1996, 71 recém-nascidos admitidos na unidade de terapia intensiva, com PN < 1.500 g e/ou IG < 31 semanas. RESULTADOS: A taxa de mortalidade foi de 29,6%; para PN < 1.000 g ou IG < 29 semanas foi de 60%, enquanto que para o escore de CRIB > 10 foi de 100%. CONCLUSÕES: O escore de CRIB > 10 correspondeu a maiores especificidade e valor preditivo positivo em relação aos demais parâmetros. A área determinada pela "receiver operating characteristic" relativa ao CRIB também foi superior. O CRIB mostrou-se um marcador mais acurado na previsão de risco de mortalidade quando comparado ao PN ou IG isoladamente.

OBJECTIVE: Several indicators, mainly birthweight and gestational age, have been used to predict the mortality risk in neonatal intensive care units. In order to assess the potential value of CRIB in predicting neonatal mortality, the score was used over the first 12 hours of life of the newborns admitted to this unit, during the year of 1996. METHOD: The inclusion criteria consisted of all infants without inevitably lethal congenital malformations, birthweight below 1,500g and/or gestational age less than 31 weeks. Newborn children who died within 12 hours after delivery were excluded. The CRIB score covers birth weight, gestational age, the presence of congenital malformations (not inevitably lethal ) and three indexes of physiological status during first 12 hours after birth - maximum and minimum appropriate fraction of inspired oxygen and maximum (most acidotic) base excess. RESULTS: In a prospective cohort, seventy one newborn children were studied. The birthweight (average) was 1,119 ± 275.6 g, gestational age 30 weeks 4/7 ±2 weeks 3/7; male (57%); Apgar 1° min. score <=3 ( 36.2%) and Apgar 5° min. score < 5 (5.8%). The mortality rate was 29.6% (gold standard). But mortality rate by birthweight less than 1,000 gr. or gestational age lower than 29 weeks was 60.0% and for the CRIB score above 10 was 100%. DISCUSSION: The specificity and predictive positive values for CRIB score above 10 were greater than any other two parameters. The area under the receiver operating characteristic (ROC) curve for predicting death was significantly greater for CRIB than for birthweight alone. It was concluded that the CRIB score is a better predictive indicator for mortality than are birthweight and gestational age.