Miller et al developed an encephalopathy score (ES) for evaluating neonates with encephalopathy. This correlates with neurodevelopmental outcome observed at 30 months. The authors are from the University of California at San Francisco.
Measurement:
(1) The neonate should not be sedated or paralyzed.
(2) The test is performed daily each day for the first 3 days of life.
(3) The ES is the maximal score out of the 3 measurements.
Parameters:
(1) feeding
(2) alertness
(3) muscle tone
(4) respiratory status
(5) reflexes
(6) seizures
|
Parameter |
Finding |
Points |
|
feeding |
normal |
0 |
|
|
gavage or gastrostomy tube |
1 |
|
|
does not tolerate oral feeding |
1 |
|
alertness |
alert |
0 |
|
|
irritable |
1 |
|
|
poorly responsive |
1 |
|
|
comatose |
1 |
|
muscle tone |
normal |
0 |
|
|
hypotonia |
1 |
|
|
hypertonia |
1 |
|
respiratory status |
normal |
0 |
|
|
on CPAP |
1 |
|
|
on mechanical ventilation |
1 |
|
reflexes |
normal |
0 |
|
|
hyperreflexia |
1 |
|
|
hyporeflexia |
1 |
|
|
absent reflexes |
1 |
|
seizures |
none |
0 |
|
|
suspected |
1 |
|
|
confirmed |
1 |
total score =
= SUM(points for all 6 parameters)
maximal score for first 3 days of life =
= MAX(ES day 1, ES day 2, ES day 3)
Interpretation:
• minimum score: 0
• maximum score: 6
• The combination of (a) maximum ES = 6 plus (b) seizures over days 1 -3 was used to identify infants with an abnormal outcome.
Performance:
• Sensitivity was 72% and specificity was 96%.
• Positive predictive value 89%
• Negative predictive value 88% (best negative predictive value was for seizures, which was 95%).
• Area under the ROC curve was 0.93.
Specialty: Neurology, Pedatrics
