Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 31247

AbstractMaterial and MethodsResultsDiscussionConclusionKey MessageAcknowledgementReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2007 | Month : February | Volume : 1 | Issue : 1 | Page : 10 - 16 Full Version

Morbidity Index: An Objective Scoring System for Predicting Neonatal Outcome

Published: February 1, 2007 | DOI:

Department of Paediatrics, Moolchand Khairati Ram hospital. Lajpat nagar,Delhi, India

Correspondence Address :
Dr Preeta Mathur


Objective: The goal of the study was to evaluate the efficacy of a scoring system called ‘morbidity index’(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.


Morbidity index, neonatal mortality, newborns


An accurate prediction of newborn status after perinatal asphyxia would be immensely beneficial as it would identify newborns at risk for short- term complications, facilitate monitoring, diagnostic tests, specific therapies and supportive interventions and considerations for new and developing therapies to minimize asphyxial injury(1). It would also help in identifying those infants on whom support can be withdrawn due to high likelihood of neonatal death and long-term morbidity. The present study is an attempt to evaluate the prognostic value of a scoring system published by Portman et al in 1990 (2) and later validated by Carter et al in 1998(3), with respect to prediction of mortality of perinatal asphyxia. The clinical scoring system as described by Portman et al, comprised of graded abnormalities of intrapartum FHR monitoring, umbilical arterial base deficit and the five-minute Apgar score for identifying term newborns at risk of multiple organ system involvement of acute perinatal asphyxia (1). As against the original study by Portman et al, the score termed morbidity index in the present study has been applied to (1) all inborn babies, irrespective of gestational age and weight. The study population therefore also includes preterm and low birth weight babies; (2) The study did not limit itself to babies that experienced acute perinatal asphyxia (3) considering the fact that asphyxia can manifest in myriad ways and other conditions may mimic asphyxia in a newborn(4), all morbidities in the early neonatal period were taken into account; (4) in addition, the score has been used to evaluate its predictive potential for long-term neurodevelopment at 9 months of age of the study subjects.

The present study is a part of a much larger study. Here we limit ourselves in presenting finding related to neonatal mortality only.

Material and Methods

The study was carried out in the neonatal unit of the department of Paediatrics, Moolchand Khairati Ram Hospital, New Delhi. This is a 350 bedded private, tertiary level multi-speciality hospital in Delhi. Approximately 900 deliveries occur every year in this hospital.

This was a prospective, analytic cohort study. In the study, 985 inborn live babies irrespective of gestational age and birth weight were enrolled. The time period of enrolment extended from December 2001 to July 2003. Infants on whom data was missing in any of the three constituent parameters (FHR,APGAR, Cord BD) were not enrolled in the study This study was done as a part of Diplomate of National Board thesis.

The Most recent Foetal Heart Rate (FHR) tracing strips prior to birth, (after admission to labour ward); arterial vessel sample, taken from a doubly clamped section of the cord; and Apgar Score was noted for each baby. These were then graded per the criteria of the Portman study (Table/Fig 1). Morbidity Index (MI) was assigned to every baby. The Primary Outcome studied was death before discharge from hospital

Assignment of Morbidity Index (MI)
It is a sum of the grades of the three parameters under study ─

MI = FHR Grade + Apgar Score Grade + Cord BD Grade

Statistical Analysis
Bi-variate logistic regression was performed using statistical package for the social sciences (SPSS version 11.5.0,, Chicago I ll,USA 2002).



Out of 985 babies enrolled – 53 %( 517) babies were males and 47 %( 468) were females (M:F=1.1:1). 86% of the babies were of term (n=847), 12 % were preterm (n=118) and 2% were postterm (n=20). Mean gestational age was 38 weeks (range 22 to 42 weeks).
The mean birth weight was 3000 (range 680 to 4900 gm). Low birth babies (birth weight < 2500 grams) formed 15.8 % (n=156).

No correlation was found between maternal parity or mode of delivery and neonatal mortality.

51 babies died. The mean wt of babies who died was 2.3 kg (median 2.3 kg) and 41% of these were male babies. Babies who left against medical advice (13) or were transferred to other hospitals (9) were excluded from all calculations involving mortality. Data on outcome of these babies was lacking.

(Table/Fig 2):(Neonatal outcome)


Morbidity index and its constituents
The following distribution of FHR pattern grades, five-minute Apgar score grades, cord base deficit grades and morbidity index was seen in the study population:

(Table/Fig 3):(FHR distribution)
(Table/Fig 4):(APGAR distribution)
(Table/Fig 5):(Cord BD distribution)
(Table/Fig 6):(MI distribution)

All the three predictors i.e. FHR pattern grades, 5 minute Apgar score grades and Cord Base Deficit grades were found to be positively associated with neonatal mortality.(p values <0.001).

(Table/Fig 7):(Morbidity index and percent of babies who died)
(Table/Fig 8):(ROC for probability of Death using MI as predictor)
(Table/Fig 9):(MI score utility Based on ROC curve)
(Table/Fig 10):(R square value after controlling for gestational age for MI and its constituent)

However the r square change was maximum for the MI than for any individual predictor, after controlling for gestational age. Therefore a combination of the three predictors (i.e. MI or Morbidity index) was found to be more accurate in predicting neonatal outcome than the three predictors taken individually. The three individual predictors were also significantly correlated with each other. (P-value <0.001).


In the present study, foetal heart rate patterns, 5 minute Apgar scores and cord blood base deficit of 985 inborn babies were graded as per Portman grading system(2). Thereby, gestational age, low birth weight babies or the presence of disease process experienced by the baby did not limit the study population. Portman et al had included only asphyxiated babies in their study. In the present study, the criterion for inclusion was not targeted at a specific disease population.

With respect to neonatal survival, both specificity (99%) and negative predictive values (96%) were found to be very high. The positive predictive value was however low at 50%.

Overall, the presence of a high MI, owing to its high specificity and negative predictive value can warn the treating physician and prompt him to heighten surveillance, plan adequate treatment and if required, transfer the baby to centres with more specialized care.

On taking the three individual predictors into consideration, a positive correlation was found between all the three of them taken separately and neonatal mortality. Foetal heart patterns were found to be associated significantly with neonatal mortality. 11 out of the 27 babies with FHR grade of 3 died. The results of the present study are in agreement with previous literature (5)(6). However the study findings did not match that of Caravale et al(7) and Leuthner et al (8) who have reported a lack of correlation between the FHR patterns and neonatal mortality.

Five-minute Apgar scores were found to be similarly significantly associated with neonatal mortality. 9 out of 18 babies with Apgar score grade of 3 (5 min Apgar 0-2) died. The results of the present study are in agreement with those of Casey et al (9) and Heller et al(10) to name a few.

There was a significant association noted between cord base deficit values and neonatal mortality in the present study. 3 out of 7 babies with base deficit grade 2(15-19meq/l) died. We did not have any baby with cord deficit more than 20 meq/l.

The presence of antenatal complications was seen to be associated with an adverse neonatal outcome. In this study, no significant correlation of the outcome with respect to sex of the baby could be ascertained. A significant correlation between gestational age and neonatal mortality was seen. Prematurity was therefore a confounding factor in the study.


Value of this scoring system lies in its immediate availability and simplicity; specificity; its potential for affecting early clinical management of the newborn, including transfer to tertiary centres and closer follow up and early rehabilitation for developmental delays. Therefore, it can be concluded that morbidity index, as compared to the three individual predictors under study, is a better predictor of neonatal outcome. It can serve as a good prognostic indicator and should be assigned to all babies at birth.


This study was done as part of a mandatory post graduate thesis by a DNB student in a private hospital. Due to the private nature of care, there is a tendency towards early withdrawal of care in
such setups. Therefore, the mortality may have been skewed upwards. Moreover, the authors did not present the data on the babies who left the hospital against medical advice. This number was significant when compared to the number of babies who died. As it is, more information on such cases would have been useful, where a moribund baby whom the parents elect to take home for final hours, rather than recording them as missing data.Similarly, with regard to those cases which were transferred to other hospitals, no data was presented. The data did not segregate the cases with congenital abnormalities. Hence, though prospective, with a large number of cases and an interesting topic, we caution the readers about the interpretation of the study results.

Key Message

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


JCDR services were used for editing and statistics in this article.


Paneth N, Fox HE. The relationship of Apgar score o neurologic handicap: a survey of clinicians. Obstet Gynecol 1983 May; 61(5): 547-550
Portman RJ, Carter BS, Gaylord MS et al. Predicting neonatal morbidity after Perinatal asphyxia: A Scoring System Am J Obstet Gynaecol, 1990, 162: 174-182.
Carter BS, McNabb Faith, Merenstein Gerald. Prospective validation of a scoring system for predicting neonatal morbidity after acute perinatal asphyxia. The Journal of Paediatrics, 1998; 132 (4): 619-623.
Paul Ekert, Max Perlman et al. Predicting the outcome of postasphyxial hypoxic-ischemic encephalopathy within 4 hours of birth. J.Pediatr, 1997 Oct; 131(4): 613-617.
Behrman, Kliegman, Jenson. The First Year. In: Nelson Textbook of Pediatrics (17th edition-2004): pg. 35
Illingworth R.S .The development of the infant and young child. Normal and abnormal. Ninth edition. Chapter 5.
Sheiner F, Hadar A, Hallak M et al. Clinical significance of fetal heart tracings during the second stage of labor. Obstet Gynecol 2001 May; 97 (5 pt1): 747-52
Berkus MD, Langer O, Samueloff A et al. Electronic fetal monitoring: what’s reassuring? Acta Obstet Gynecol Scand 1999 Jan; 78(1): 15-21.
Caravale B, Allemand F et al. Factors predictive of seizures and neurologic outcome in perinatal depression. Pediatr Neurol 2003 Jul; 29 (1): 18-25.
Leuthner SR, Das UG. Low Apgar scores and the definition of birth asphyxia. Pediatr Clin North A 2004 Jun; 51 (3): 737-45.
Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. New England Journal of Medicine 2001 Feb 15; 344 (7): 467-471.
Heller G, Schnell RR et al. Umbilical blood pH, Apgar scores and early neonatal mortality.Z.Geburtshilfe Neonatol 2003 May-Jun; 207 (3): 84-9.
Talati AJ, Yang W et al. Combination of early perinatal factors

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)