Comparison of Early outcome of Extremely Low Birth Weight (ELBW) Infants befor and after running (Implementation) the pallivative Care protocol according to CRIB II scoring system in the tabriz alzahra hospital

Abstract

The mortality and morbidity rate of extremely low birth weight infants (ELBW) with birth weight under 1000 gr is high and the highest mortality and morbidity rate and the highest days stayed in NICU belong to these very low birth weight infants. Clinicians determine the grade of risk incurred on any neonate according to their clinical condition, and based on that, determine the probability of death and the occurrence of certain complications, and implement treatment planes based on it in consultation with parents. In the past, two factors, gestational age and neonatal weight, have traditionally been used to predict the probability of neonatal survival. The purpose of this study is to use the CRIB II (Clinical Risk Index for Babies scoring system) to determine the prognosis of patients and how to provide care for the baby based on that criterion and of course in consultation with parent. Futile care was also calculated in two groups. Materials and Methods: In this study, neonates 24/+0-26/+6 weeks post- natal under primary care measures of respiratory support and maintaining heat chain, hospitalized in the NICU ward of Alzahra Hospital in Tabriz and scored based on CRIB II scoring system (CRIB II score criteria include:weight At birth, intrauterine age, sex of the newborn, infants`temperature during hospitalization serum alkaline deficiency. If the score is CRIB II ˂11, all medical procedures were performed for the patient, and if the score is CRIB II ≥ 12, Infants were divided into two groups. If the infant was born through assisted reproductive technology (IUI_IVF) or the parents were willing to provide comprehensive support after consultation on prognosis and possible complications, then Comprehensive measures (including Mechanical ventilation /nasal CPAP and surfactant therapy and intravenous fluids maintaining ,TPN and stable core temperatures) was performed for their infants.Other infants recived only palliative care ( respiratory support with surfactant therapy and intravenous fluids maintaining ,TPN and stable core temperatures). Results: The findings of our study showed positive predictive value (PPV) of 88% for CRIB II scores equal to or greater than11, ie 88% of infants with scores equal to or greater than 11 died in CRIB II. This is consistent with previous studies, therefore the CRIB II score can be used to predict the neonatal outcome . Mortality rate in the palliative care group was significantly higher than the Comprehensive support group. Also, our study showed that futile care was significantly higher in the Comprehensive support group than the palliative care group.