Patient selection: Neonates with meconium-stained amniotic fluid.
Parameters:
(1) Apgar score at 1 minute
(2) Apgar score at 5 minutes
(3) delivery by Caesarean section
(4) gestational age in weeks
|
Parameter
|
Finding
|
Points
|
|
Apgar score at 1 minute
|
> 6
|
0
|
|
|
<= 6
|
1
|
|
Apgar score at 5 minutes
|
> 6
|
0
|
|
|
<= 6
|
1
|
|
Caesarean section
|
no
|
0
|
|
|
yes
|
1
|
|
gestational age
|
< 42 weeks
|
0
|
|
|
>= 42
|
1
|
where:
• The reason for the Caesarean section is not mentioned. My guess is that it refers to an emergency Caesarean section for fetal distress.
number of risk factors =
= SUM(points for the 4 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 4
• About 10% of infants with 1 or more risk factors developed the meconium aspiration syndrome. The presence of 1 or more risk factors was 91% and 84% specific for predicting development of the meconium aspiration syndrome. The negative predictive value was 96% but the positive predictive value was only 10%.
• The most sensitive single risk factor was an Apgar score <= 6 at 1 minute (45%), but this was only 87% specific. The most specific single risk factor was an Apgar score <= 6 at 5 minutes, but this was only 31% sensitive.
