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 Release 22.0, Sept. 2008
 
The Medical Algorithms Project
Chapter : ch44. Pediatrics Section : Assessment of Neonatal Well-Being and Development
  Nursery Neurobiologic Risk Score

  Online Excel Reference
Copyright (c) 2008-2010, Institute for Algorithmic Medicine, Houston, TX, USA. All rights reserved.

Overview :

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):

• born at a gestational age of 28 weeks or less

• include those that survived until discharge

• 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%

 

  References:

Brazy JE, Eckerman CO, et al. Nursery Neurobiologic Risk Score: Important factors in predicting outcome in very low birth weight infants. J Pediatrics. 1991; 118: 783-792.

Brazy JE, Goldstein RF, et al. Nursery Neurobiologic Risk Score: levels of risk and relationships with nonmedical factors. Developmental and Behavioral Pediatrics. 1993; 14: 375-380.

Lefebvre F, Gregoire M-C, et al. Nursery Neurobiologic Risk Score and outcome at 18 months. Acta Paediatr. 1998; 87: 751-757.

 

 
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