Ray et al reported a modification of the Sick Neonate Score (SNS) of Rathod et al. The authors are from Calcutta Medical College and the Institute of Postgraduate Medical Education and Research in Kolkata, West Bengal.
Patient selection: sick neonate, <= 37.5°C
Parameters on arrival at hospital unchanged from the SNS:
(1) respiratory rate with breaths per minute
(2) heart rate with beats per minute
(3) axillary temperature in °C
(4) capillary filling time in seconds
(5) oxygen saturation on room air in percent
|
Parameter |
Finding |
Points |
|
respiratory rate |
apnea or grunting |
0 |
|
|
< 40 breaths per minute |
0 |
|
|
40 to 60 breaths per minute (normal) |
2 |
|
|
> 60 breaths per minute (tachypnea) with or without retractions |
1 |
|
heart rate |
asystole |
0 |
|
|
< 100 (bradycardia) |
0 |
|
|
100 to 160 (normal) |
2 |
|
|
> 160 (tachycardia) |
1 |
|
axillary temperature |
< 36°C |
0 |
|
|
36 to 36.5°C |
1 |
|
|
36.5 to 37.5°C |
2 |
|
capillary filling time |
< 3 seconds |
2 |
|
|
3 to 5 seconds |
1 |
|
|
> 5 seconds |
0 |
|
oxygen saturation |
> 92% |
2 |
|
|
85 to 92% |
1 |
|
|
< 85% |
0 |
Parameter changed from the SNS
(6) mean arterial blood pressure
(7) random blood glucose
|
Parameter |
Finding |
Points |
|
mean blood pressure |
< 5th percentile |
0 |
|
|
5 to 50th percentile |
1 |
|
|
> 50th percentile |
2 |
|
random blood sugar |
< 45 mg/dL |
0 |
|
|
45 to 60 mg/dL |
1 |
|
|
> 60 mg/dL |
2 |
Parameters added:
(8) Moro reflex
(9) modified Downes' score, from 0 to 10
|
Parameter |
Finding |
Points |
|
Moro reflex |
absent |
0 |
|
|
depressed |
1 |
|
|
appropriate for gestational age |
2 |
|
|
exaggerated |
1 |
|
modified Downes' score |
> 6 |
0 |
|
|
2 to 6 |
1 |
|
|
0 or 1 |
2 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 18
• A score <= 11 was associated with increased risk of in-hospital mortality for a term neonate.
• A score <= 12 was associated with increased risk of mortality for preterm neonates.
Performance:
• A score <= 11 showed a sensitivity is 86% and specificity 90%.
Specialty: Psychiatry
