Identification of the High Risk Neonate Using the Score of Hobel et al.

Description

Hobel et al developed scores to screen a fetus or neonate for risk of serious complications. They identified factors which were assigned weighted values based on the assumed risk. These were divided into prenatal, intrapartum and neonatal groups. The patients were studied from 1969 to 1971.

Scores:

(1) for prenatal factors

(2) for intrapartum factors

(3) for neonatal factors

Prenatal Factors

Factor	Finding	Points
cardiovascular and renal	moderate to severe toxemia	10
	mild toxemia	5
	history of eclampsia	5
	history of toxemia	1
	chronic hypertension	10
	moderate to severe renal disease	10
	severe heart disease, Class II-IV	10
	mild heart disease, Class I	5
	history of pyelitis	5
	acute pyelonephritis	5
	history of cystitis	1
	acute cystitis	1
metabolic	diabetes >= Class A-II	10
	prediabetes (A-I)	5
	family history of diabetes	1
	previous endocrine ablation	10
	thyroid disease	5
previous histories	previous fetal exchange transfusion for Rh	10
	previous stillbirth	10
	post-term > 42 weeks	10
	previous premature infant	10
	previous neonatal death	10
	previous cesarean section	5
	habitual abortion	5
	infant > 10 pounds	5
	multiparity > 5	5
	epilepsy	5
	fetal anomalies	1
anatomic abnormalities	uterine malformations	10
	incompetent cervix	10
	abnormal fetal position	10
	polyhydramnios	10
	small pelvis	5
miscellaneous	abnormal cervical cytology	10
	multiple pregnancy	10
	sickle cell disease	10
	maternal age <= 15, or >= 35	5
	viral disease	5
	Rh sensitization only	5
	positive serology (for syphilis)	5
	severe anemia, < 9 g/dL hemoglobin	5
	mild anemia, 9-10.0 g/dL hemoglobin	1
	excessive use of drugs (and alcohol)	5
	moderate alcohol use	1
	history of TB or PPD >= 10 mm	5
	maternal weight < 100 pounds, or > 200 pounds	5
	pulmonary disease	5
	flu syndrome, severe	5
	vaginal spotting	5
	smoking >= 1 pack per day	1
	emotional problems	1

where:

• Class of heart disease is taken as the New York Heart Association functional classification

• scoring 10 points for abnormal cervical cytology seems excessive unless it is carcinoma

Implementation:

• only 1 score given to toxemia, history of eclampsia and history of toxemia

• only 1 score given for diabetes and history of diabetes

• only 1 score given for urinary tract infections and history of urinary tract infections

• only 1 score for severe flu-like illness or viral disease

• only 1 score for previous fetal exchange for Rh disease and Rh sensitization only

• only 1 score for drugs and alcohol use

Intrapartum Factors

Factor	Finding	Points
maternal factors	moderate to severe toxemia	10
	mild toxemia	5
	polyhydramnios	10
	oligohydramnios	10
	amnionitis	10
	uterine rupture	10
	premature rupture of the membranes > 12 hours	5
	primary dysfunctional labor	5
	secondary arrest of dilation	5
	demerol > 500 mg	5
	magnesium sulfate > 25 grams	5
	labor > 20 hours	5
	second stage > 2.5 hours	5
	precipitous labor < 3 hours	5
	clinical small pelvis	5
	medical induction	5
	primary cesarean section	5
	repeat cesarean section	5
	elective induction	1
	prolonged latent phase	1
	uterine tetany	1
	pitocin augmentation	1
placental factors	placenta previa	10
	abruptio placentae	10
	post-term > 42 weeks	10
	meconium stained amniotic fluid, dark	10
	meconium stained amniotic fluid, light	5
	marginal separation	1
fetal factors	abnormal presentation	10
	multiple pregnancy	10
	fetal bradycardia > 30 minutes	10
	breech delivery total extraction	10
	breech delivery spontaneous or assisted	5
	prolapsed cord	10
	fetal weight < 2,500 grams	10
	fetal acidosis pH < 7.25 (Stage I)	10
	fetal tachycardia > 30 minutes	10
	operative forceps or vacuum extraction	5
	outlet forceps	1
	general anesthesia	5
	shoulder dystocia	1

Neonatal Factors

Factor	Finding	Points
general	prematurity < 2,000 grams	10
	prematurity 2,000 - 2,500 grams	5
	Apgar at 1 minute < 5	5
	Apgar at 5 minutes < 5	10
	resuscitation at birth	10
	fetal anomalies	10
	dysmaturity	5
	feeding problem	1
	multiple births	1
respiratory	respiratory distress syndrome (RDS)	10
	meconium aspiration syndrome	10
	congenital pneumonia	10
	anomalies of the respiratory system	10
	apnea	10
	other respiratory distress	10
	transient tachypnea	5
metabolic disorders	hypoglycemia	10
	hypocalcemia	10
	hypomagnesemia	5
	hypermagnesemia	5
	hypoparathyroidism	5
	failure to gain weight	1
	jitteriness or hyperactivity with specific causes	1
cardiac	major cardiac anomalies which require immediate catheterization	10
	cardiac anomalies not requiring immediate catheterization	5
	congestive heart failure	10
	persistent cyanosis	5
hematologic problems	hyperbilirubinemia	10
	hemorrhagic diathesis	10
	chromosomal anomalies	10
	sepsis	10
	anemia	5
CNS	CNS depression > 24 hours	10
	CNS depression <= 24 hours	5
	seizures	10

Implementation:

• reduced most of the respiratory distress conditions to 1 score

score for prenatal factors =

= SUM(points assigned for prenatal factors)

score for intrapartum factors =

= SUM(points assigned for intrapartum factors)

score for neonatal factors =

= SUM(points assigned for neonatal factors)

Interpretation:

• minimum score: 0

• maximum scores: > 60

Score	Risk
< 10	low
>= 10	high

• If an infant identified as high risk by prenatal factors but low risk in the intrapartum or neonatal scores, then there was no significant increase in neonatal morbidity or perinatal mortality.

• If the intrapartum risk is high, then there is increased neonatal morbidity and perinatal mortality.

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Description

Specialty

ICD-10