Very premature infants are at risk for abnormal neurodevelopmental outcome. The Nursery Neurobiologic Risk Score can be used to predict outcomes at 18 months for very premature infants.
Infants (for Lefebvre):
(1) born at a gestational age of 28 weeks or less
(2) include those that survived until discharge
(3) birthweights ranged from 585-1450 grams
Parameters:
(1) ventilation
(2) pH
(3) seizures
(4) intraventricular hemorrhage (IVH)
(5) periventricular leukomalacia (PVL)
(6) infection
(7) hypoglycemia (glucose < 1.7 mmol/L, or < 30 mg/dL)
|
Parameter |
Finding |
Points |
|---|---|---|
|
ventilation |
no |
0 |
|
|
<= 7 days |
1 |
|
|
8 – 28 days |
2 |
|
|
> 28 days (cumulative) |
4 |
|
pH |
never < 7.15 |
0 |
|
|
< 7.15 for <= 1 hour |
1 |
|
|
< 7.15 for <= 2 values |
1 |
|
|
< 7.15 (bicarbonate < 16 mmol/L) for > 1 hour |
2 |
|
|
< 7.15 (bicarbonate < 16 mmol/L) for > 2 values |
2 |
|
|
< 7.0 (bicarbonate < 16 mmol/L) |
2 |
|
|
cardiopulmonary arrest (not at birth) |
4 |
|
seizures |
none |
0 |
|
|
controlled on 1 drug and normal interictal EEG |
1 |
|
|
not controlled on 1 drug and/or abnormal interictal EEG |
2 |
|
|
status epilepticus >= 12 hours with abnormal EEG |
4 |
|
intraventricular hemorrhage |
none |
0 |
|
|
subependymal germinal matrix hemorrhage only |
1 |
|
|
blood in one or both ventricles (grade II-III) |
2 |
|
|
intraparenchymal blood (grade IV) |
4 |
|
|
hydrocephalus |
4 |
|
periventricular leukomalacia |
none |
0 |
|
|
mild (questionable changes) which resolve |
1 |
|
|
moderate (definite) which resolve |
2 |
|
|
cyst formation |
4 |
|
|
cerebral atrophy with large ventricles |
4 |
|
infection |
none |
0 |
|
|
possible (negative blood cultures) |
0 |
|
|
highly suspicious (placed on 10 day course of antibiotics) |
1 |
|
|
positive blood cultures with normal blood pressure |
1 |
|
|
septic shock |
2 |
|
|
meningitis (positive CSF cultures) |
4 |
|
hypoglycemia |
no |
0 |
|
|
asymptomatic and <= 6 hours |
1 |
|
|
asymptomatic and > 6 hours |
2 |
|
|
symptomatic and < 24 hours |
2 |
|
|
symptomatic and >= 24 hours |
4 |
from Table 1, page 752, Lefebvre (1998); Table 1, page 376, Brazy (1993)
where:
• mild or moderate periventricular leukomalacia: increase in echogenicity in periventricular area
• septic shock: (a) positive blood cultures and (b) blood pressure < 35 mm Hg at <= 750 grams or blood pressure < 40 at 751-1500 grams.
• hypoglycemia "symptomatic and < 24 hours": I added "and < 24 hours" to match the pattern shown by the other entries in the table
neurobiologic risk score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 28
• The higher the score, the worse the outcome at 18 months.
|
Score |
Risk Group |
Mean Developmental Scores |
Risk of Developmental Quotient < 90 |
|---|---|---|---|
|
0 – 4 |
low |
101 +/- 9 |
12% |
|
5 – 7 |
moderate |
92 +/- 19 |
24% |
|
>= 8 |
high |
76 +/- 24 |
71% |
|
Risk Group |
Risk Any Disability |
Risk of Cerebral Palsy |
Risk of Severe Disability |
|---|---|---|---|
|
low |
16% |
4% |
0% |
|
moderate |
30% |
19% |
24% |
|
high |
71% |
41% |
50% |
Specialty: Pedatrics
ICD-10: ,
