The CRIB (Clinical Risk Index for Babies) score can be used to assess the risks for a neonate shortly after birth. It uses both birthweight and other clinical information, yet is intended to be simple and robust. It can be used to compare the performance of neonatal intensive care units.
Newborn infants are assessed for:
(1) birthweight
(2) gestational age in weeks
(3) congenital malformations
(4) base excess
(5) FIO2 required to maintain adequate oxygenation
Exclusion: infants with inevitably lethal congenital malformations
|
Parameter |
Finding |
Points |
|
birthweight |
> 1350 grams |
0 |
|
|
851-1350 grams |
1 |
|
|
701-850 grams |
4 |
|
|
<= 700 grams |
7 |
|
gestation in weeks |
> 24 weeks |
0 |
|
|
<= 24 weeks |
1 |
|
congenital malformations |
none |
0 |
|
|
not acutely life threatening |
1 |
|
|
acutely life threatening |
3 |
|
maximum base excess in first 24 hours |
> -7.0 mmol/L |
0 |
|
|
-7.0 to -9.9 mmol/L |
1 |
|
|
-10 to -14.9 mmol/L |
2 |
|
|
<= -15 mmol/L |
3 |
|
minimum appropriate FIO2 in first 12 hours |
<= 0.40 |
0 |
|
|
0.41-0.60 |
2 |
|
|
0.61-0.90 |
3 |
|
|
0.91-1.00 |
4 |
|
maximum appropriate FIO2 in first 12 hours |
<= 0.40 |
0 |
|
|
0.41-0.80 |
1 |
|
|
0.81-0.90 |
3 |
|
|
0.91-1.00 |
5 |
where:
• Base excess in mmol/L converts directly (conversion factor 1.0) to mEq/L
• Appropriate FIO2 is defined as that associated with (1) arterial or transcutaneous oxygen tension of 6.7-10.7 kPa (factor for conversion to mm Hg 7.519; 50.4-80.5 mm Hg), or (2) an arterial hemoglobin oxygen saturation of 88-95%
CRIB score =
= (points for birthweight) + (points for gestational age) + (points for congenital malformations) + (points for base excess) + (points for minimum FIO2) + (points for maximum FIO2)
Interpretation:
• maximum score 23
• minimum score 0
• with increasing scores there is increased morbidity and mortality
|
CRIB score |
hospital mortality |
major cerebral abnormality in survivors before discharge |
|
0-5 |
8% |
5% |
|
6-10 |
38% |
12% |
|
11-15 |
70-76% |
20% |
|
> 16 |
85-90% |
20% |
Limitations (Parry et al):
• Data may be used that is up to 12 hours after admission, which may introduce early treatment bias.
• It was developed using data from 1988 to 1990 and may not reflect contemporary data.
Specialty: Critical Care, Emergency Medicine, Pedatrics
