Prospective validation of a scoring system for predicting neonatal morbidity after acute perinatal asphyxia.
OBJECTIVE
To prospectively validate a previously reported scoring system for identifying the near-term infant at risk for the multiple organ system sequelae of acute perinatal asphyxia.


METHODS
Prospective observational study.


METHODS
Three Denver teaching hospitals, each providing comprehensive obstetric care.


METHODS
Newborn infants of 36 weeks or more gestation.


METHODS
None.


METHODS
Chi-squared analysis with Fisher's exact test.


RESULTS
Scores consisting of graded abnormalities in fetal heart rate monitoring, umbilical arterial base deficit, and 5-minute Apgar score were calculated by the research nurse after admission of the infant to the nursery (range of possible scores, 0 to 9). A second nurse, blinded to these data, prospectively followed the newborn's hospital course for multiple organ system morbidity.


RESULTS
Three thousand two hundred thirty-eight newborns were studied; 366 required neonatal intensive care unit admission. Eleven newborns had a score > or = 6 (mean umbilical artery pH = 6.98, base deficit = 17.1 mEq/L). Morbidities in these 11 newborns included seizures (2), hypoxic-ischemic encephalopathy (5), respiratory distress (9), hypotension (7), renal dysfunction (9), hypoglycemia/hypocalcemia (4), and thrombocytopenia or disseminated intravascular coagulopathy (3). The odds ratio (OR) and 95% confidence interval (CI) for newborns admitted to the neonatal intensive care unit with a score > or = 6 for having multiple organ system morbidity, defined as three or more affected organ systems, was 38.5 (95% CI, 9.2 to 127.8). The scoring system showed a stronger relationship with multiple organ system morbidity than did isolated individual indicators commonly used to identify asphyxia calculated on the same subjects: for those with pH < 7.00, OR 24 (95% CI, 6.4 to 94.1); base deficit > or = 10 mEq/L, OR 4.5 (95% CI, 1.9 to 10.3), and 5-minute Apgar score < or = 3, OR 7.4 (95% CI, 1.3 to 38.1).


CONCLUSIONS
This scoring system, encompassing both immediate intrapartum and postpartum measures and acid-base status proximate to the time of delivery, is useful for rapidly identifying the term and near-term newborn at risk for multiple organ system morbidity after acute perinatal asphyxia.
Carter
B S
BS
Department of Pediatrics, Fitzsimons Army Medical Center, Denver, Colorado, USA.
McNabb
F
F
Merenstein
G B
GB
D000138:Acidosis / Q000175:diagnosis / Q000453:epidemiology; D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000150:complications / Q000453:epidemiology*; D005312:Fetal Blood / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D009017:Morbidity; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index