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  • Original Article
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A New Score for Predicting Neonatal Very Low Birth Weight Mortality Risk in the NEOCOSUR South American Network

Journal of Perinatology volume 25, pages 577–582 (2005)Cite this article

Abstract

OBJECTIVE:

To develop and validate a model for very low birth weight (VLBW) neonatal mortality prediction, based on commonly available data at birth, in 16 neonatal intensive care units (NICUs) from five South American countries.

STUDY DESIGN:

Prospectively collected biodemographic data from the Neonatal del Cono Sur (NEOCOSUR) Network between October 2000 and May 2003 in infants with birth weight 500 to 1500?g were employed. A testing sample and crossvalidation techniques were used to validate a statistical model for risk of in-hospital mortality. The new risk score was compared with two existing scores by using area under the receiver operating characteristic curve (AUC).

RESULTS:

The new NEOCOSUR score was highly predictive for in-hospital mortality (AUC=0.85) and performed better than the Clinical Risk Index for Babies (CRIB) and the NICHD risk models when used in the NEOCOSUR Network. The new score is also well calibrated — it had good predictive capability for in-hospital mortality at all levels of risk (HL test=11.9, p=0.85). The new score also performed well when used to predict in hospital neurological and respiratory complications.

CONCLUSIONS:

A new and relatively simple VLBW mortality risk score had a good prediction performance in a South American network population. This is an important tool for comparison purposes among NICUs. This score may prove to be a better model for application in developing countries.

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References

  1. The International Network Group. The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. Lancet 1993;342:193–198.

  2. Horbar JD, Onstad L, Wright E, The National institute of Child Health and Human Development Neonatal Research Network. Predicting mortality risk for infants weighing 501 to 1500 grams at birth: The National Institutes of Health Neonatal Research Network report. Crit Care Med 1993;21:12–17.

    Article  CAS  Google Scholar 

  3. Hammermeister KE, Johnson R, Marshall G, Grover FL . Continuous assessment and improvement in quality of care. Ann Surg 1994;219:281–290.

    Article  CAS  Google Scholar 

  4. Marshall G, Shroyer ALW, Grover FL, Hammermeister KE . Time series monitor of outcomes: a new dimension of measuring quality of care. Med Care 1998;36:348–356.

    Article  CAS  Google Scholar 

  5. Richardson DK, Gray JE, McCormick MC, et al. Score for neonatal acute physiology (SNAP): validation of a new physiology-based severity of illness. Pediatrics 1993;91:617–623.

    CAS  Google Scholar 

  6. Richardson DK, Corcoran JD, Escobar GJ, Lee SK, for the Canadian NICU Network. SNAP-II and SNAAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001;138:92–100.

    Article  CAS  Google Scholar 

  7. Juez G, Lucero E, Ventura-Juncá P, Gonzalez H, Tapia JL, Winter A . Crecimiento intrauterino en recién nacidos de clase media. Rev Chil Pediatr 1989;60:198–202.

    CAS  PubMed  Google Scholar 

  8. Efron B . Estimating the error rate of a prediction rule: Improvement on cross-validation. J Am Statist Assoc 1983;78:316–331.

    Article  Google Scholar 

  9. Hanley JA, McNeil BJ . The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29–36.

    Article  CAS  Google Scholar 

  10. DiCiccio TJ, Efron B . More accurate confidence intervals in exponential families. Biometrika 1992;79:231–245.

    Article  Google Scholar 

  11. Hosmer DW, Lemeshow S . Applied Logistic Regression, 2nd ed. New York, NY: John Wiley and Sons; 2000.

    Book  Google Scholar 

  12. Chambers JM, Hastie TJ . Statistical Models in S. New York: Chapman & Hall; 1992.

    Google Scholar 

  13. Bancalari A, Abdenour G, Feller R, Gannon J . Bronchopulmonary dysplasia: clinical presentation. J Pediatr 1979;95:819–822.

    Article  CAS  Google Scholar 

  14. Papile L, Bursten J . Incidence and evolution of subependimal and intraventricular hemorrhage. A study of infants with birth weights less than 1500?g. J Pediatr 1978;92:529–534.

    Article  CAS  Google Scholar 

  15. Grupo Colaborativo NEOCOSUR. Very low birth weight infants outcome in 11 South American NICU's. J Perinat 2002;22:2–7.

  16. Richardson DK, Phibbs CS, Gray JE, et al. Birth weight and severity illness: independent predictors of neonatal mortality. Pediatrics 1993;91:969–975.

    CAS  Google Scholar 

  17. Richardson DK, Tarnow-Mordi WO, Escobar GJ . Neonatal risk scoring systems. Clin Perinat 1998;25:591–611.

    Article  CAS  Google Scholar 

  18. de Courcy-Wheeler RH, Wolfe RH, Fitzgerald A, et al. Use of the CRIB core in prediction of neonatal morbidity and mortality. Arch Dis Child Fetal Neonatal Ed 1996;74:F79–F80.

    Google Scholar 

  19. Khanna R, Taneja V, Singh SK, et al. The clinical risk index for babies (CRIB) score in India. Indian J Pediatr 2002;69:957–960.

    Article  Google Scholar 

  20. Pollack MM, Koch MA, Bartel DA, et al. A comparison of neonatal mortality risk prediction models in very low birth weight infants. Pediatrics 2000;105:1051–1057.

    Article  CAS  Google Scholar 

  21. Maier RF, Rey M, Metze BC, et al. Comparison of mortality risk: a score for very low birthweight infants. Arch Dis Child 1997;76:F146–F151.

    Article  CAS  Google Scholar 

  22. Lago P, Freato F, Bettiol T, et al. Is the CRIB score a valid tool in predicting neurodevelopmental outcome in extremely low birth weight infants? Biol Neonate 1999;76:220–227.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Linda Wright, MD and Abik Das, PhD for their useful suggestions and help in preparing this manuscript.

Author information

Authors and Affiliations

  1. Departamento de Salud Publica Universidad Catolica, Santiago, Chile

    Guillermo Marshall PhD

  2. Unidad de Neonatologia Hospital Clinico Universidad Catolica, Santiago, Chile

    Jose L Tapia MD, Ivonne D'Apremont MD, Jose Lacarruba MD & Jorge Fabres MD

  3. Maternidad Sarda, Buenos Aires, Argentina

    Carlos Grandi PhD

  4. Unidad de Neonatologia Hospital Lagomaggiore, Mendoza, Argentina

    Claudia Barros MD

  5. Unidad de Neonatologia Hospital Sotero del Rio, Santiago, Chile

    Angelica Alegria MD

  6. Unidad de Neonatologia Hospital Gustavo Fricke, Viña del Mar, Chile

    Jane Standen MD

  7. Recien Nacidos Facultad de Medicina, Montevideo, Uruguay

    Ruben Panizza MD

  8. Unidad de Neonatologia Hospital Juan Fernandez, Buenos Aires, Argentina

    Liliana Roldan MD

  9. Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina

    Gabriel Musante MD

  10. Hospital Guillermo Grant, Concepcion, Chile

    Aldo Bancalari MD

  11. Unidad de Neonatologia Hospital Cayetano Heredia, Lima, Peru

    Enrique Bambaren MD

  12. Hospital de Clinicas de Asuncion, Paraguay

    Jose Lacarruba MD

  13. Hospital Clinico Universidad de Chile, Santiago, Chile

    Maria E Hubner MD

  14. Sanatorio de la Trinidad, Buenos Aires, Argentina

    Marcelo Decaro MD

  15. Unidad de Neonatologia Hospital Italiano, Buenos Aires, Argentina

    Gonzalo Mariani MD

  16. Unidad de Neonatologia Hospital de Clinicas Universidad de Buenos Aires, Argentina

    Isabel Kurlat MD

  17. Unidad de Neonatologia Hospital San Jose, Santiago, Chile

    Agustina Gonzalez MD

Authors
  1. Guillermo Marshall PhD
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  2. Jose L Tapia MD
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  3. Ivonne D'Apremont MD
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  4. Carlos Grandi PhD
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  5. Claudia Barros MD
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  6. Angelica Alegria MD
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  7. Jane Standen MD
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  8. Ruben Panizza MD
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  9. Liliana Roldan MD
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  10. Gabriel Musante MD
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  11. Aldo Bancalari MD
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  12. Enrique Bambaren MD
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  13. Jose Lacarruba MD
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  14. Maria E Hubner MD
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  15. Jorge Fabres MD
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  16. Marcelo Decaro MD
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  17. Gonzalo Mariani MD
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  18. Isabel Kurlat MD
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  19. Agustina Gonzalez MD
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Consortia

For the Grupo Colaborativo NEOCOSUR

Appendix A1

Appendix A1

Participants Centers and Local Coordinators Grupo Colaborativo Neocosur in this study:

Argentina

  • Clínica y Maternidad Suizo Argentina, Buenos Aires: Gabriel Musante, Luis Prudent, Marcio Alazrraqui.

  • Hospital de Clínicas Jose de San Martín, Buenos Aires: Isabel Kurlat, Adriana Azcarate, Oscar Di Siervi.

  • Hospital Italiano, Buenos Aires: Gonzalo Mariani, Jose María Ceriani, Silvia Fernandez.

  • Hospital Juan Fernández, Buenos Aires: Liliana Roldan, Ileana Seguel, Hector Sexer.

  • Hospital Lagomaggiore, Mendoza: Claudia Barros, Daniel Agost, Gabriela Torres, Augusto Fischetti, Jorge Ríos.

  • Maternidad Sarda, Buenos Aires: Carlos Grandi, Monica Brundi, Nora Balanian, Claudio Solana, Miguel Larguia.

  • Sanatorio de la Trinidad, Buenos Aires: Marcelo Decaro, Nestor Vain.

Chile

  • Hospital Clinico Universidad Católica de Chile, Santiago: Jorge Fabres, Alberto Estay, Jose L Tapia, Alvaro Gonzalez.

  • Hospital Clinico Universidad de Chile, Santiago: María Eugenia Hübner, Rodrigo Ramírez, Jaime Burgos.

  • Hospital Guillermo Grant, ConcepciOn: Aldo Bancalari, Paulina Bello, Rodrigo Bustos, Lilian Cifuentes, Juan Fasce.

  • Hospital Gustavo Fricke, Viña del Mar: Jane Standen, Marisol Escobar, Antonio Salvado, Alejandra Nuñez.

  • Hospital San Jose, Santiago: Agustina González, Ana Luisa Candia, Lorena Tapia.

  • Hospital Dr. Sotero del Rio, Santiago: Angélica Alegría, Enrica Pittaluga, Patricia Mena.

Paraguay

  • Hospital de Clínicas de Asuncion: Jose Lacarruba, Ramón Mir.

Perú

  • Hospital Cayetano Heredia, Lima: Enrique Bambaren, Veronica Webb, Marilu Rospigliosi, Jaime Zegarra.

Uruguay

  • Facultad de Medicina Servicio de Recien Nacidos, Montevideo: Ruben Panizza, Sandra Gugliucci, Silvia Fernández, Ana Santos, Eduardo Mayans.

DataBase Unit Members

  • Sandra Vignes, Ivonne D'Apremont, Jose L Tapia, Hernan Gonzalez, Guillermo Marshall, Alessandra Gederlini, Cristian Vilches, Macarena Icaza, Renato Venegas.

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Marshall, G., Tapia, J., D'Apremont, I. et al. A New Score for Predicting Neonatal Very Low Birth Weight Mortality Risk in the NEOCOSUR South American Network. J Perinatol 25, 577–582 (2005). https://doi.org/10.1038/sj.jp.7211362

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