PROSPECTIVE VALIDATION OF A SCORING SYSTEM FOR PREDICTING NEONATAL MORBIDITY AFTER ACUTE PERINATAL ASPHYXIA

Objective: To prospectively validate a previously reported scoring sys tem for identifying the near-term infant at risk for the multiple orga n system sequelae of acute perinatal asphyxia. Study design: Prospecti ve observational study: Setting: Three Denver teaching hospitals, each providing comprehensive obstetric care. Subjects: Newborn infants of 36 weeks or more gestation. Intervention: None. Statistical analysis: Chi-squared analysis with Fisher's exact test. Outcome: Scores consist ing 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, pros pectively followed the newborn's hospital course for multiple organ sy stem morbidity. Results: Three thousand two hundred thirty-eight newbo rns were studied; 366 required neonatal intensive care unit admission. Eleven newborns had a score greater than or equal to 6 (mean umbilica l artery pH = 6.98, base deficit = 17.1 mEq/L). Morbidities in these 1 1 newborns included seizures (2), hypoxic-ischemic encephalopathy (5), respiratory distress (9), hypotension (7), renal dysfunction (9), hyp oglycemia/hypocalcemia (4), and thrombocytopenia or disseminated intra vascular coagulopathy (3). The odds ratio (OR) and 95% confidence inte rval (CI) for newborns admitted to the neonatal Intensive care unit wi th a score greater than or equal to 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 relations hip with multiple organ system morbidity than did isolated individual indicators commonly used to identify asphyxia calculated on the same s ubjects: for those with pH < 7.00, OR 24 (95% CI, 6.4 to 94.1); base d eficit greater than or equal to 10 mEq/L, OR 4.5 (95% CI, 1.9 to 10.3) , and 5-minute Apgar score less than or equal to 3, OR 7.4 (95% CI, 1. 3 to 38.1). Conclusion: This scoring system, encompassing both immedia te intrapartum and postpartum measures and acid-base status proximate to the time of delivery, is useful for rapidly identifying the term an d near-term newborn at risk for multiple organ system morbidity after acute perinatal asphyxia.