Saldanha et al describe the Neonatal Status Score (NSS) used to evaluate critically ill newborn infants before and during transfer. This can help identify infants who require closer monitoring and more aggressive management. The authors are from East Carolina University School of Medicine in Greenville, North Carolina.
NOTE: The assessment is performed by a specialized neonatal transport team. The score shares several parameters with the TRIPS (above).
Parameters:
(1) body temperature in °F
(2) heart rate
(3) respirations
(4) skin color
(5) systolic blood pressure in mm Hg
(6) skin perfusion
(7) response to noxious stimuli
(8) blood glucose in mg/dL (using Dextrostix)
|
Parameter |
Finding |
Points |
|
body temperature |
97.5 - 99°F |
2 |
|
|
> 99°F |
1 |
|
|
< 97.5°F |
0 |
|
heart rate |
100 - 180 beats per minute |
2 |
|
|
> 180 beats per minute |
1 |
|
|
< 100 beats per minute |
0 |
|
respirations |
< 60 per minute AND no distress |
2 |
|
|
>= 60 per minute, grunting, retraction |
1 |
|
|
severe distress, apnea, gasping, bagging, intermittent positive pressure ventilation (IPPV) |
0 |
|
skin color |
pink |
2 |
|
|
dusky |
1 |
|
|
cyanotic |
0 |
|
systolic blood pressure |
> 40 mm Hg |
2 |
|
|
30 - 40 mm Hg |
1 |
|
|
< 30 mm Hg |
0 |
|
skin perfusion |
capillary refill <= 1 second |
2 |
|
|
capillary refill > 1 second |
1 |
|
|
mottling, poor perfusion |
0 |
|
response to noxious stimuli |
activity, withdraws |
2 |
|
|
slow response |
1 |
|
|
no response |
0 |
|
blood glucose |
45 - 130 mg/dL |
2 |
|
|
> 130 mg/dL |
1 |
|
|
< 45 mg/dL |
0 |
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• The lower the score the worse the infant's status.
• Mortality is affected by availability of advanced life support and the mode of transport (helicopters would be expected to be lower).
|
Total Score Prior to Transport |
Long-Term Mortality Rate |
|
0 to 9 |
37% |
|
10 to 12 |
20% |
|
13 to 16 |
6% |
Specialty: Critical Care, Emergency Medicine
ICD-10: ,
