Morbidity Index: An Objective Scoring System for Predicting Neonatal Outcome
Dr Preeta Mathur
Objective: The goal of the study was to evaluate the efficacy of a scoring system called â€˜morbidity indexâ€™(MI) consisting of a combination of grades of electronic foetal heart rate patterns, five-minute Apgar scores and cord arterial base deficit to predict death before discharge in neonatal period.
Design: This was a prospective, analytic cohort study.
Methods & Material: 985 live born infants irrespective of gestational age and birth weight were enrolled. A relevant obstetric history was recorded for each case. FHR, umbilical cord (arterial) blood base deficit (BD)values and 5 minute Apgar scores of all babies were collected and graded as per Portman(1990) criteria ( Grades (GR)of Foetal Heart Rate patterns: GR 0 - Normal tracings, GR I-Variable decelerations, GR II -Severe Variable / Late decelerations, GR III Prolonged bradycardia; 5 minute Apgar score grades: GR 0 - > 6, GR I - 5 - 6, GR II 3 - 4, GR III 0 - 2; Cord blood BD grades: GR 0 BD - <10mEq/L, GR I BD 10 -14 mEq/L, GR II BD 15 -19 mEq/L, GR III BD ≥ 20 mEq/L.) All the grades were added up to form the MI for each baby (MI = FHR GR + Apgar Score GR + Cord BD GR). The MI was then analyzed statistically for its efficacy in predicting neonatal mortality.
Results: Larger MI values were found to predict neonatal mortality with better specificity than the three predictors taken individually. However sensitivity of MI was relatively low.
Conclusion: Morbidity index, as compared to the three individual predictors under study, is a better predictor of neonatal mortality. This is easy to do and the score provides more information than the traditional Apgar score.