The Neonatal Stabilization Score (NSS) can be used to assess the care of neonates weighing less than 1,000 grams (about 2.2 pounds) at birth who are transported to a referral center. This can be used to audit the medical care received. The authors are from the New York University School of Medicine in New York City.
Measures:
(1) vital signs
(2) laboratory investigations
(3) respiratory support
(4) IV fluid administration
(5) specific management
Measure |
Actions |
Points |
---|---|---|
vital signs |
not performed |
0 |
|
incomplete (not all performed) |
1 |
|
complete |
2 |
laboratory investigations |
no studies done |
0 |
|
incomplete |
1 |
|
complete |
2 |
respiratory support |
none given when required |
0 |
|
inappropriate |
1 |
|
appropriate |
2 |
IV fluid administration |
not started |
0 |
|
type and/or rate of fluids administered inadequate or inappropriate |
1 |
|
adequate |
2 |
specific management |
none done when indicated |
0 |
|
incomplete |
1 |
|
done when indicated |
2 |
after Table 1, page 181
where:
• Complete vital signs: temperature, heart rate, respiratory rate, blood pressure.
• Complete laboratory studies: hematocrit, blood glucose, sepsis workup if indicated, chest X-ray if in respiratory distress.
• Indications for sepsis workup: maternal fever, mother on antibiotics, prolonged rupture of the membranes for > 24 hours.
• Sepsis workup: blood, urine and CSF cultures (or attempt at lumbar puncture).
• Appropriate respiratory support: (a) no respiratory distress and no action taken; (b) respiratory distress treated adequately with oxygen and respiratory support
• Indications for supplemental oxygen: mild respiratory distress and/or when PaO2 < 50 mm Hg.
• Indications for more than supplemental oxygen: moderate or severe respiratory distress and/or when PaCO2 > 50 mm Hg.
• Inappropriate fluid administration: fluid containing electrolytes during the first day, D10W when dextrostix > 175 mg%; D5W when dextrostix < 25 mg%; blood transfusion not administered for a patient is in respiratory distress and the hematocrit is < 40%.
• Adequate fluid maintenance rate: 80 – 100 mL/kg/day in the first day of life.
• Specific management includes administration of antibiotics, placement of catheters, chemical resuscitation, and treatment of shock.
• Administration of antibiotics: indicated for any patient in whom systemic cultures were done, when there is a history of maternal fever. or possible infection in the infant.
• All infants with an endotracheal tube were felt to need an umbilical artery catheter.
• Chemical resuscitation: administration of sodium bicarbonate when acidosis is stated or blood pH < 7.25 with PaCO2 < 50 mm Hg.
• Management of shock include transfusion of plasma expanders.
neonatal stabilization score =
= SUM(points for all 5 measures)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score, the better stabilized the neonate was prior to transport. A score of 10 indicates excellent stabilization.
• In evaluating performance, a NSS < 6 was considered low.
Performance:
• Interrater agreement on chart review was good, with Kappa 0.76.
Purpose: To evaluate the transportation of a premature neonate using the Neonatal Stabilization Score.
Specialty: Critical Care, Emergency Medicine
Objective: severity, prognosis, stage
ICD-10: R57,