Thompson et al developed a scoring system for evaluating neonates with hypoxic-ischemic encephalopathy (HIE). The score correlated with neurodevelopmental outcome at 1 year. The authors are from the University of Cape Town in South Africa.
Patient selection:
(1) It is performed on a newborn infant on the first, second and third days of life.
(2) It can be performed on a neonate on a ventilator.
(3) It cannot be applied to a neonate who is paralyzed.
Parameters:
(1) tone
(2) level of consciousness
(3) fits (seizures)
(4) posture
(5) Moro response
(6) grasp reflex
(7) sucking reflex
(8) respirations
(9) tension of the fontanelle
|
Parameter |
Finding |
Points |
|
tone |
normal |
0 |
|
|
hypertonia |
1 |
|
|
hypotonia |
2 |
|
|
flaccid |
3 |
|
level of consciousness |
normal |
0 |
|
|
hyper-alert, stare |
1 |
|
|
lethargic |
2 |
|
|
comatose |
3 |
|
fits (seizures) |
none |
0 |
|
|
infrequent |
1 |
|
|
frequent (> 2 per day) |
2 |
|
posture |
normal |
0 |
|
|
fisting, cycling |
1 |
|
|
strong, distal flexion |
2 |
|
|
decerebrate |
3 |
|
Moro response |
normal |
0 |
|
|
partial |
1 |
|
|
absent |
2 |
|
grasping reflex |
normal |
0 |
|
|
poor |
1 |
|
|
absent |
2 |
|
sucking reflex |
normal |
0 |
|
|
poor |
1 |
|
|
absent with or without bites |
2 |
|
respirations |
normal |
0 |
|
|
hyperventilation |
1 |
|
|
brief episodes of apnea |
2 |
|
|
apnea requiring intermittent positive pressure ventilation (IPPV) |
3 |
|
tension of the fontanelles |
normal |
0 |
|
|
full but not tense |
1 |
|
|
tense |
2 |
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum total score: 0
• maximum total score: 22
• A total score >= 15 correlated with a poor neurodevelopmental outcome at 1 year.
Performance:
• positive predictive value: 92%
• negative predictive value: 82%
Specialty: Neurology, Pedatrics
