Razi Journal of Medical Sciences
مجله علوم پزشکی رازی
RJMS
Medical Sciences
http://rjms.iums.ac.ir
39
journal39
2228-7043
2228-7051
en
jalali
1393
8
1
gregorian
2014
11
1
21
125
online
1
fulltext
fa
بررسی فاکتورهای خطر کلینیکی ((Clinical Risk Index for babies در پیش گویی بقای نوزادان با وزن بسیار کم
Evaluation of clinical risk factors ((Clinical Risk Index for babies in predicting survival of extremely low birth weight infants
نوزادان
Neonatology
پژوهشي
Research
<p style="direction: rtl"><font face="Times New Roman"><font size="3"> </font><font face="tahoma,arial,helvetica,sans-serif" size="2"><strong>زمینه و هدف:</strong> تقریباً</font></font><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><font size="2"> 4%</font>-7% از کل تولدهای زنده را نوزادان
با وزن تولد خیلی کم(</span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">VLBW</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><span dir="rtl"></span><span dir="rtl"></span>) شامل میشوند که میزان مرگ و
میر آنها بالا است و نزدیک به 30% از مرگهای اولیه نوزادان را شامل میشود. اخیراً
برخی سیستمهای نمره دهی نظیر </span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">Clinical Risk Index for Babies(CRIB) </span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1">و(</span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">SNAP</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><span dir="rtl"></span><span dir="rtl"></span>)</span><span dir="ltr"></span><span dir="ltr"></span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> Score for Neonatal Acute
Physiology</span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1">برای
ارزیابی میزان خطر مرگ ومیر نوزادان ایجاد شده است. هدف از این تحقیق، تعیین ارزش
اخباری </span><span dir="ltr"></span><span dir="ltr"></span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span>(Clinical
Risk Index for babies)CRIB</span><span dir="rtl"></span><span dir="rtl"></span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font size="2">برای بقای نوزادان متولد شده با وزن خیلی کم</font></span></span><span dir="ltr"></span><span dir="ltr"></span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span>(VLBW)</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><span dir="rtl"></span><span dir="rtl"></span> است.<o:p /></span></p><p style="direction: rtl"><font face="Times New Roman" size="3"> </font><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><strong>مواد و روشها:</strong> دراین مطالعه مقطعی که از سال 1381
تا 1387 صورت گرفت، نمره </span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">CRIB</span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1">برای 494 نوزادی که<span style="mso-spacerun: yes"><font size="2"> </font></span>با وزن کمتر از 1500 گرم و سن حاملگی کمتر از
37 هفته به دنیا آمده بودند و در این مطالعه وارد شدند، محاسبه شد. همچنین ارزش اخباری
</span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">CRIB</span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1">برای مرگ ومیر نوزادان تعیین و با ارزش اخباری سن حاملگی و
وزن تولد مقایسه گردید.<o:p /></span></p><p><font face="Times New Roman" size="3"> </font></p><p class="MsoNormal" style="margin: 0cm 0cm 10pt line-height: 150%" dir="rtl"><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><strong>یافته ها:</strong> از494 نوزادی که با وزن تولد خیلی
کم،مورد مطالعه قرار گرفتند،261 نوزاد از بین رفتند که شامل 52.5 % از نمونه مورد
مطالعه بود.میانگین نمره </span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">CRIB</span><span dir="rtl"></span><span dir="rtl"></span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><span dir="rtl"></span><span dir="rtl"></span> </span><span dir="ltr"></span><span dir="ltr"></span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span>14.52
± 2.4 (range: 7-25)</span><span dir="rtl"></span><span dir="rtl"></span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font size="2">محاسبه شد. میانگین </font></span></span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">CRIB</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><span dir="rtl"></span><span dir="rtl"></span>
نوزادانی که از بین رفتندبه طور قابل ملاحظه ای بالاتر از نوزادانی بود که زنده
ماندند</span><span dir="ltr"></span><span dir="ltr"></span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span>(15.34
± 2.6 vs. 13.5 ± 1.7 p<0.001)</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><span dir="rtl"></span><span dir="rtl"></span>.در
آنالیز نمودار </span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">Receiver
Operator Characteristic (ROC)</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><span dir="rtl"></span><span dir="rtl"></span>،نقطه
</span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">cut off </span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1">مطلوب برای نمره </span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">CRIB</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><span dir="rtl"></span><span dir="rtl"></span> که بتواند نوزادان در خطر مرگ را شناسایی
کند،13 محاسبه شد که حساسیت 82% ،ویژگی 50%، ارزش اخباری مثبت 65% ،و ارزش اخباری
منفی72% را نشان داد.حساسیت ،ویژگی،ارزش اخباری مثبت و منفی سن حاملگی زیر 31هفته
برای پیش بینی میزان مرگ ومیر به ترتیب 83% ،63%،71% و 77% تعیین گردید.همچنین
حساسیت ،ویژگی،ارزش اخباری مثبت و منفی وزن تولد با نقطه </span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">cut off</span><span dir="rtl"></span><span dir="rtl"></span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font size="2">1000 گرم، برای پیش بینی میزان مرگ و میر به ترتیب 35% ،92%، 84% و 56%
محاسبه شد.<o:p /></font></span></span></p><p style="direction: rtl"><font face="Times New Roman" size="3"> </font><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><strong>نتیجه گیری:</strong> اگرچه نمره </span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">CRIB</span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1">برای شناخت نوزادانی که در خطر مرگ هستند و نیز پیش بینی
کردن وضعیت نوزادان مورد استفاده قرار میگیرد،با این حال، ارزش اخباری </span><span style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1" dir="ltr">CRIB</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="color: black line-height: 150% font-family: "Tahoma","sans-serif" font-size: 8pt mso-themecolor: text1"><span dir="rtl"></span><span dir="rtl"></span> بیشتر از وزن تولد ویا سن حاملگی نیست.<o:p /></span></p><p><font face="Times New Roman" size="3"> </font></p>
<font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0cm 0cm 10pt text-align: left line-height: 150% unicode-bidi: embed direction: ltr"><span style="color: black line-height: 150% font-family: "Arial","sans-serif" font-size: 12pt mso-themecolor: text1 mso-bidi-font-family: Arial mso-ascii-theme-font: minor-bidi mso-hansi-theme-font: minor-bidi mso-bidi-theme-font: minor-bidi"><strong>Objective:</strong> Very low birth weight(VLBW) babies constitute
approximately 4%-7% of all live births and the mortality in this subgroup is
high, contributing to as much as 30% of early neonatal deaths.</span><span style="color: black line-height: 150% font-size: 14pt mso-themecolor: text1 mso-fareast-font-family: "Times New Roman" mso-bidi-language: AR-SA mso-fareast-theme-font: minor-fareast"><font face="Calibri"> </font></span><span style="color: black line-height: 150% font-family: "Arial","sans-serif" font-size: 12pt mso-themecolor: text1 mso-bidi-font-family: Arial mso-ascii-theme-font: minor-bidi mso-hansi-theme-font: minor-bidi mso-bidi-theme-font: minor-bidi">Some scoring system like the
Clinical Risk Index for Babies(CRIB) Score and the Score for Neonatal Acute
Physiology (SNAP), for assessing the risk of mortality frequently utilized in
newborns. The predictive value of CRIB (Clinical Risk Index for babies) for the
survival of very low birth weight neonates(VLBW) was determined.<o:p /></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0cm 0cm 10pt text-align: left line-height: 150% unicode-bidi: embed direction: ltr"><span style="color: black line-height: 150% font-family: "Arial","sans-serif" font-size: 12pt mso-themecolor: text1 mso-bidi-font-family: Arial mso-ascii-theme-font: minor-bidi mso-hansi-theme-font: minor-bidi mso-bidi-theme-font: minor-bidi"><strong>Methods:</strong> In this cross-sectional study from 2002 to 2008,
the CRIB score was applied to all newborns (n=494) with a birth weight of
<1,500 g and gestational age <37 weeks. Predictive value of CRIB
(Clinical Risk Index for Babies) for mortality of neonates was determined and
compared with that of gestational age and birth weight. <o:p /></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0cm 0cm 10pt text-align: left line-height: 150% unicode-bidi: embed direction: ltr"><span style="color: black line-height: 150% font-family: "Arial","sans-serif" font-size: 12pt mso-themecolor: text1 mso-bidi-font-family: Arial mso-ascii-theme-font: minor-bidi mso-hansi-theme-font: minor-bidi mso-bidi-theme-font: minor-bidi"><strong>Results:</strong><font size="3"><font face="Arial"><span style="mso-spacerun: yes"> </span>Four
hundred ninety four very low birth weight neonates were included in this study.
From those, 261 were expired giving a mortality rate of 52.5%. The mean CRIB
was 14.52 ± 2.4 (range: 7-25).Mean CRIB of expired neonates was significantly
higher than survivors (15.34 ± 2.6 vs. 13.5 ± 1.7 p<0.0001). In the
Receiver Operator Characteristic (ROC) analysis, the optimal cutoff point for
the CRIB score to identify neonates at the risk of mortality was 13 with 82%
sensitivity, specificity of 50%, positive predictive value of 65% and negative
predictive value of 72%. Sensitivity, specificity, positive and negative
predictive values of gestational age under 31 weeks for predicting mortality
were also 83%,63%,71% and 77%, respectively. In addition, sensitivity,
specificity, positive and negative predictive values of birth weight for
predicting mortality with the cutoff point of 1000 gr were 35% ,92%,84%, and
56%,respectively.<o:p /></font></font></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0cm 0cm 10pt text-align: left line-height: 150% unicode-bidi: embed direction: ltr"><span style="color: black line-height: 150% font-family: "Arial","sans-serif" font-size: 12pt mso-themecolor: text1 mso-bidi-font-family: Arial mso-ascii-theme-font: minor-bidi mso-hansi-theme-font: minor-bidi mso-bidi-theme-font: minor-bidi"><strong>Conclusion:</strong> CRIB score can be used for identifying
neonates at risk of mortality and predicting the neonatal outcome. However, the
predictive value of CRIB is not higher than birth weight or gestational age. <o:p /></span></p><font face="Times New Roman" size="3"> </font>
,CRIB(Clinical Risk Index for Babies)نوزادان با وزن تولد خیلی کم(Very Low Birth Weight-VLBW), سن حاملگی
CRIB(Clinical Risk Index for Babies),Very Low Birth Weight-VLBW, Gestational age
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http://rjms.iums.ac.ir/browse.php?a_code=A-10-1-1601&slc_lang=fa&sid=1
Nastaran
khosravi
نسترن
خسروی
3900319475328460027466
3900319475328460027466
No
Iran university of medical sciences
دانشگاه علوم پزشکی ایران
Niloofar
khosravi
نیلوفر
خسروی
3900319475328460027467
3900319475328460027467
Yes
Iran university of medical sciences
دانشگاه علوم پزشکی ایران