USE OF THE LABORATORY IN PREDICTION OF OUTCOME IN THE HIGH-RISK NEWBORN

This paper reviews our ability to predict survival and neurodevelopmen tal outcome in the newborn period. Traditionally, prognosis is based o n individual risk factors or disease states. The laboratory plays an i mportant role in diagnosing some of these. For example, prenatal and n ewborn screening are important in the diagnosis of chromosomal abnorma lities and inborn errors of metabolism. Abnormal bilirubin, glucose, a nd pH values in the newborn period are risk factors for death and abno rmal neurodevelopment, and the degree of abnormality imparts additiona l information. Many newborns have multisystem disorders, and it is onl y when multiple variables are considered that outcome can be predicted . Three neonatal scores that incorporate multiple variables are discus sed. Methodologic difficulties in determining outcome are reviewed and illustrated with survival and morbidity rates of very premature babie s. The laboratory is one of many prognostic variables. The evaluation of how laboratory services are provided is difficult but important.