Methods of Mortality Risk Adjustment in the NICU

A 20-Year Review

NICU mortality risk-adjustment scores vary widely by the data collected and the timing of collection.

Babies in hospital neonatal intensive care units (NICUs) can vary greatly in gestational age, birthweight for age, and clinical comorbidities. In order to improve care delivery and be able to meaningfully compare provider and institutional performance, experts apply various mortality risk-adjustment methods.

These investigators reviewed the literature of the last 20 years to identify unique methods of mortality risk-adjustment in the NICU. They found that neonatal mortality risk-adjustment scores contained more than 48 distinct components, with each score containing from six to 28 components measuring elements such as birthweight, gestational age, mode and site of delivery, blood pressure, heart rate, major diagnostic classification, and timing of data collection, most usually at time of admission.

They identified 10 unique neonatal mortality risk scores. The most frequently cited approach was the Clinical Risk Index for Babies (CRIB) published in 1993, with 447 citations. When adjusted for the number of years since publication, however, the most widely referenced score was the more recent (2008) National Institute of Child Health and Human Development “calculator” for clinicians; with 37 citations per year.

As clinical innovations occur and the underlying risk of mortality changes, approaches to risk-adjustment need to reflect those advances.

Read more about the study.