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Comparing mortality risk models in VLBW and preterm infants: systematic review and meta-analysis

Journal of Perinatology volume 40, pages 695–703 (2020)Cite this article

Subjects

Abstract

Objective

To compare the prognostic accuracy of six neonatal illness severity scores (CRIB, CRIB II, SNAP, SNAP II, SNAP-PE, and SNAP-PE II), birthweight (BW), and gestational age (GA) for predicting pre-discharge mortality among very low birth weight (VLBW) infants (<1500 g) and very preterm infants (<32 weeks’ gestational age).

Study design

PubMed, EMBASE, and Scopus were the data sources searched for studies published before January 2019. Data were extracted, pooled, and analyzed using random-effects models and reported as AUC with 95% confidence intervals (CI).

Results

Of 1659 screened studies, 24 met inclusion criteria. CRIB was the most discriminate for predicting pre-discharge mortality [AUC 0.88 (0.86–0.90)]. GA was the least discriminate [AUC 0.76 (0.72–0.80)].

Conclusions

Although the original CRIB score was the most accurate predictor of pre-discharge mortality, significant heterogeneity between studies lowers confidence in this pooled estimate. A more precise illness severity score to predict pre-discharge mortality is still needed.

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Fig. 1: PRISMA systematic review flow diagram.
Fig. 2: Forest Plots for GA, BW, CRIB, and CRIB II.

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Acknowledgements

We would like to thank Marisa Conte, Assistant Director of Research and Informatics at the University of Michigan Taubman Health Sciences Library, for assisting us with the database search.

Funding

Summer Biomedical Research Program, University of Michigan Medical School.

Author information

Author notes

  1. These authors contributed equally: Jennifer S. McLeod, Anitha Menon

Authors and Affiliations

  1. Department of Surgery, Section of Pediatric Surgery, University of Michigan, Michigan Medicine, Ann Arbor, MI, 48109, USA

    Jennifer S. McLeod, Samir K. Gadepalli, George B. Mychaliska & Erin E. Perrone

  2. University of Michigan Medical School, Ann Arbor, MI, 48109, USA

    Anitha Menon

  3. Department of Surgery Statistics, University of Michigan, Michigan Medicine, Ann Arbor, MI, 48109, USA

    Niki Matusko

  4. University of Michigan, Michigan Medicine, Fetal Diagnosis and Treatment Center, Ann Arbor, MI, 48109, USA

    Gary M. Weiner, Samir K. Gadepalli, John Barks, George B. Mychaliska & Erin E. Perrone

  5. Department of Pediatrics, Neonatal-Perinatal Medicine Division, University of Michigan, Michigan Medicine, Ann Arbor, MI, 48109, USA

    Gary M. Weiner & John Barks

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Contributions

Dr. McLeod and Ms. Menon designed the study, collected data, drafted the initial paper, and reviewed and revised the final paper. Ms. Matusko assisted with design of the study, provided statistical analysis, drafted the statistics section of the initial paper, and reviewed and revised the final paper. Drs. Weiner, Gadepalli, Barks, and Mychaliska assisted with the concept and design of the study and critically reviewed and revised the paper for important intellectual content. Dr. Perrone conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed and revised the paper for important intellectual content and accuracy.

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Correspondence to Erin E. Perrone.

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McLeod, J.S., Menon, A., Matusko, N. et al. Comparing mortality risk models in VLBW and preterm infants: systematic review and meta-analysis. J Perinatol 40, 695–703 (2020). https://doi.org/10.1038/s41372-020-0650-0

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