Parameter

Finding

Points

Apgar score (see below)

no neurobehavioral abnormalities

0

hyperalert

1

mild hypotonia

2

severe hypotonia

3

EEG

EEG not performed

0

normal EEG

0

abnormal EEG but normal at discharge

1

abnormalities on EEG (not flat or periodic) with continued abnormalities at discharge

2

periodic or flat EEG with continued abnormalities at discharge

3

seizures (nonmetabolic)

no problem

0

suspected seizure; not treated with anticonvulsants

1

1 or more seizures with response to a single anticonvulsant

2

1 or more seizures with resistance to therapy requiring 2 or more anticonvulsants

3

intracranial hemorrhage

CT scan or ultrasound not performed

0

CT scan or ultrasound negative

0

subarachnoid hemorrhage with seizures

1

grade I intraventricular hemorrhage (IVH)

1

grade II intraventricular hemorrhage

1

grade III intraventricular hemorrhage

2

grade IV intraventricular hemorrhage

3

hydrocephalus

no evidence of hydrocephalus on ultrasound or CT scan

0

suspected on clinical basis; resolved without treatment

1

hydrocephalus confirmed on ultrasound or CT scan without shunt; treated medically or repeated intraventricular taps

2

hydrocephalus confirmed on ultrasound or CT scan with shunt required

3

CNS findings without hydrocephalus or intracranial hemorrhage

CT scan or ultrasound not done

0

CT scan or ultrasound negative

0

abnormal findings with return to normal prior to discharge

1

identified abnormalities not specified elsewhere without return to normal prior to discharge

2

loss of parenchyma, decreased mantle or other abnormalities which may result in parenchymal injury not specified elsewhere

3

premature with weight > 3rd percentile

> 32 weeks

0

32-30 weeks

1

29-27 weeks

2

26-24 weeks

3

weight for gestational age

weight appropriate for gestational age

0

< 10th percentile for weight but > 3rd percentile

1

< 3rd percentile for weight

2

< 3rd percentile for weight with a 2 or 3 in other categories of the perinatal index

3

dysmorphic features

none

0

1 minor dysmorphic feature

0

2 minor dysmorphic features

1

3 or more minor dysmorphic features

2

1 major feature, with normal chromosomes

2

chromosomal abnormalities or syndrome known to be associated with developmental disabilities such as Down's syndrome

3

fetal alcohol syndrome

3

ventilation

not ventilated

0

<= 7 days

1

8-21 days

2

> 21 days

3

clinical diagnosis of bronchopulmonary dysplasia with tachypnea

head growth (premature infant hospitalized 6 weeks or more)

head growth > 10% and < 90% for gestational age with 3.5 cm or greater growth in first 6 weeks

0

initial head circumference in the 5th-10th percentile with 3.5 cm or greater growth in the first 6 weeks

1

initial circumference > 3rd percentile with less than 3.5 cm growth in first 6 weeks

2

initial head circumference < 3rd percentile for gestational age with < 3.5 cm for first 6 weeks

3

head growth (term infant hospitalized > 3 weeks)

initial head circumference >= 10th percentile with average head growth >= 0.3 cm per week

0

initial head circumference >= 10th percentile with average head growth < 0.29 cm per week

1

initial head circumference below the 10th percentile with average head growth >= 0.3 cm per week

2

initial head circumference below the 10th percentile with average head growth < 0.29 cm per week

3

polycythemia

hematocrit <= 65%

0

hematocrit > 65% and < 70% without exchange transfusion

1

hematocrit > 65% without symptoms, with exchange transfusion

2

hematocrit > 65% requiring exchange transfusion because of hypoglycemia, lethargy, apnea or seizures

3

meningitis

none

0

suspected diagnosis on clinical or laboratory basis without bacterial or viral confirmation

1

confirmed diagnosis with or without seizures with adequate tone and state control within 24 hours

2

confirmed diagnosis with persistent hypotonia or obtunded state or seizures which persist for more than 72 hours

3

hypoglycemia

no hypoglycemia

0

hypoglycemia without symptoms, requiring oral feedings only

1

hypoglycemia with lethargy or hypotonia, requiring treatment with IV glucose

2

hypoglycemia with seizures, requiring treatment with IV glucose, glucagon or corticotropin

3

congenital infection

no suspicion of congenital infection

0

suspected but without viral or serologic confirmation

1

suspected, may include small for gestational age only, with viral or serologic confirmation

2

clearly identified diagnosis by culture or serology associated with signs and symptoms (i.e., jaundice, chorioretinitis, hepatosplenomegaly)

3

hyperbil