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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Functional and behavioral responses as marker of illness, and outcome in infants under 2 months
1Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh.
Insights
Abnormal infant behaviors like decreased activity and abnormal cry can signal serious illness. These functional and behavioral assessments help predict infant outcomes and guide treatment decisions.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Clinical Assessment Tools
Background:
- Early identification of serious illness in infants is crucial for timely intervention.
- Functional and behavioral assessments offer potential indicators of infant health status.
- Existing diagnostic tools may not always be readily available or sufficient for rapid assessment.
Purpose of the Study:
- To evaluate the diagnostic value of 11 functional and behavioral items in infants up to 2 months of age.
- To identify associations between these items and serious illness, bacteremia, and patient outcomes (recovery or death).
- To assess the predictive capability of these items for therapeutic decision-making.
Main Methods:
- A study involving 116 infants evaluated for suspected sepsis.
- Assessment of 11 functional and behavioral items, graded on a 3-point severity scale, conducted before detailed clinical examination.
- Statistical analyses including lambda-2 test, Pearson's correlation, and multiple stepwise regression were employed.
Main Results:
- Six items significantly associated with serious illness: decreased activity, abnormal cry quality, pallor, rapid breathing, decreased consolability, and altered consciousness level.
- A six-item model demonstrated high sensitivity (>90%) and negative predictive value (>95%) for serious illness.
- Consciousness level was the strongest predictor of outcome, followed by feeding, hydration, color, consolability, and expression; a score of 7+ on the six items predicted death with 80% sensitivity and 97% negative predictive value.
Conclusions:
- Functional and behavioral responses are valuable indicators for predicting infant illness severity and outcomes.
- Specific observable items can effectively identify serious illness and aid in risk stratification.
- These findings support the development of a clinical scale based on these items to assist in therapeutic decisions for infants.
Abstract:
Value of abnormal findings on 11 functional and behavioral items were studied for identification of serious illness, presence of bacteremia and prediction of the outcome (recovery or death) in infants upto 2 months of age. All the items were graded on a 3 point scale (0, 1 and 2) in the ascending order of severity. A total of 116 infants who were being evaluated for suspected sepsis were enrolled. The assessment was completed before detailed history and physical examination. Significant associations were observed between presence of serious illness and six items by lambda2-test and/or Pearson's correlation and multiple stepwise regression analysis. These were decreased activity, abnormal quality of cry, presence of pallor, fast breathing, decreased consolability, and consciousness level. The sensitivity of six item model was > 90% and negative predictive value >95%. The negative predictive value of several individual items was also above 90%. Consciousness level was the most important predictor of the outcome followed by poor feeding, hydration, color, consolability and abnormal expression (combined multiple R = 0.51). A total score of 7 or more on above six items had a sensitivity of 80%, and negative predictive value of 97% for death. In conclusion, behavior and functional responses (as mentioned above) were fairly useful in predicting the outcome and/or the severity of the illness. These items may be combined to develop a scale to help in therapeutic decision making.
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