Senthil Murugan, S (2013) Use of Stops as a Prognostic Indicator of Outcome of New Born Babies admitted in NICU. Masters thesis, Chengalpattu Medical College, Chengalpattu.
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Abstract
INTRODUCTION: NEONATAL PERIOD: Newborn or Neonatal period is counted from birth up to 28 days of life. Early neonatal period accounts to first 7 days or 168 hours of life whereas late neonatal period extends from 7 days to under 28 completed days of life. GESTATIONAL AGE AND BIRTH WEIGHT CLASSIFICATION: As for as possible Neonates should be classified by gestational age, because this is more meaningful than that based on birth weight. GESTATIONAL AGE CLASSIFICATION: 1.Assessment will be based on first day of the last menstrual period And ultrasonic estimation.3 2. The modified Dubowitz(Ballard) examination for newborns may be useful in confirming or supplementing gestational age estimation. 3.Infant can be classified by post menstrual age as follows a)preterm: less than 37 completed weeks(259 days) b)term: 37 to less than 42 completed weeks(260-294 days) c)post –term: 42 weeks (295 days) or more d)late preterm is recently emerging classification referring to subgroups of infants between 34 and 38 weeks gestation. AIM OF THE STUDY: The aim and objective of the study is to assess the usefulness of the indigenously developed simple cheap and easy to perform physiological scoring system “STOPS” in estimating the prognostic accuracy of the outcome of babies admitted in our NICU. Study design Prospective analytical study Setting 20 bedded secondary care referral NICU of Govt. chengalpattu medical college hospital located in chengalpattu Study period 4 months (march 2012 to june 2012) DISCUSSION: Though STOPS score was useful in predicting the outcome of the babies admitted in NICUs, at the end of our study we found that the prognostic accuracy was limited by the following factors in our study. This study was done in a level 2 NICU . The sample size was 771 with most of the babies admitted in a more stable physiological status with the mean STOPS score of 1.08, median of 0 and standard deviation of 1.601. our study included all the babies admitted in our newborn care unit including those babies admitted for observation , preterm or low birth weight babies for care, neonatal depression, meconium stained babies for observation. In future, larger multicentric trials with larger sample size, including babies needing level 3 NICU care, will certainly establish the prognostic accuracy of the STOPS score. In addition we also observed that if STOPS score is extended giving weightage for gestational age and birth weight the prognostic accuracy can further be improved. CONCLUSION : STOPS is a useful scoring system in predicting the outcome of the babies admitted in NICUs. In our study it has been observed that in overall a STOPS score of 3 or more is a good predictor of the death of the babies admitted in NICU. The ROC curve including all babies showed that the best cut off value for predicting the non survival status ( death ) was a score of 3 or more with the area under the curve being 0.955 .Its sensitivity was 87.5% with lower and upper (95%) confidence intervals 77.23, 93.53 , specificity was 91.41% with lower and upper (95%) confidence intervals 88.98,93.34 , positive predictive value was 50.45% with lower and upper (95%) confidence intervals 41.29, 59.58 and negative predictive value was 98.65% with lower and upper (95%) confidence intervals 97.36 , 99.31. its diagnostic accuracy in predicting death was 91.05% with lower and upper (95%) confidence intervals 88.91 ,92.94. Coming to the term babies the observations were similar. . The ROC curve for term babies showed that the best cut off value for predicting the non survival status ( death ) was a score of 3 or more with the area under the curve being 0.962 ts sensitivity was 93.94% with lower and upper (95%) confidence intervals 80.39 ,98.32 specificity was 92.28% with lower and upper (95%) confidence intervals 89.62 ,94.30 positive predictive value was 44.29% with lower and upper (95%) confidence intervals 33.25,55.92 and negative predictive value was 99.57% with lower and upper (95%) confidence intervals 89.82,94.33 . its diagnostic accuracy in predicting death was 92.38% with lower and upper (95%) confidence intervals 89.92 , 94.33. The ROC curve for preterm babies showed that the best cut off value for predicting the non survival status ( death ) was a score of 2 or more with the area under the curve being 0.939 .Its sensitivity was 96.77% with lower and upper (95%) confidence intervals 83.81,99.43 , specificity was 77.04% with lower and upper (95%) confidence intervals 69.25, 83.32 , positive predictive value was 49.18% with lower and upper (95%) confidence intervals 37.06, 61.40 and negative predictive value was 99.05% with lower and upper (95%) confidence intervals 94.8, 99.83 . its diagnostic accuracy in predicting death was 80.72% with lower and upper (95%) confidence intervals 74.05, 86.0. The ROC curve for very low birth weight babies showed that the best cut off value for predicting the non survival status ( death ) was a score of 3 or more with the area under the curve being 0.993 .Its sensitivity was 100% with lower and upper (95%) confidence intervals 70.08, 100 , specificity was 93.75% with lower and upper (95%) confidence intervals 71.67, 98.89 , positive predictive value was 90% with lower and upper (95%) confidence intervals 59.58, 98.21 and negative predictive value was 100% with lower and upper (95%) confidence intervals 79.61, 100 . its diagnostic accuracy in predicting death was 96% with lower and upper (95%) confidence intervals 80.46, 99.29. The ROC curve for low birth weight babies showed that the best cut off value for predicting the non survival status ( death ) was a score of 2 or more with the area under the curve being 0.923 .Its sensitivity was 93.33% with lower and upper (95%) confidence intervals 78.68, 98.15 , specificity was 74.63% with lower and upper (95%) confidence intervals 68.19, 80.14 , positive predictive value was 35.44% with lower and upper (95%) confidence intervals 25.80,46.44 and negative predictive value was 98.68% with lower and upper (95%) confidence intervals 95.33, 99.64 . its diagnostic accuracy in predicting death was 77.06% with lower and upper (95%) confidence intervals 71.22,82.01. The ROC curve for normal birth weight babies showed that the best cut off value for predicting the non survival status ( death ) was a score of 3 or more with the area under the curve being 0.973 .Its sensitivity was 100% with lower and upper (95%) confidence intervals 86.68, 100 , specificity was 91.96% with lower and upper (95%) confidence intervals 88.98, 94.19 , positive predictive value was 42.37% with lower and upper (95%) confidence intervals 30.67, 55.07 and negative predictive value was 100% with lower and upper (95%) confidence intervals 99.02, 100 . its diagnostic accuracy in predicting death was 92.41% with lower and upper (95%) confidence intervals 89.58, 94.52. Statistical analysis using simple (uni variate logistic regression ) showed that all the individual variables gestational age( p value.001), birth weight (p value .001) , sensorium( p value .001) ,temperature( p value .001) ,oxygenation status( p values .013 for score 1 and .001 for score 2) , perfusion( p value .001) ,and sugar levels ( p values .007 for score 1 and, 0.001 for score 2) had significant effect on neonatal mortality with p values < 0.05 Statistical analysis with multi variate logistic regression showed that the variables birth weight( p values .011 for VLBW babies and .008 for LBW babies ), sensorium( p values .001 ) perfusion ( p value .036 )and Oxygenation status( p value .001 for score of 2) had statistically signicant effects on the mortality of the babies whereas gestational age, temperature, and sugar levels did not have statistically significant effects on the mortality of the babies. From the above statistical analytic results it can be concluded that STOPS score is a useful tool in predicting the outcome of the babies admitted in NICUs.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Prognostic Indicator ; Outcome ; New Born Babies ; NICU. |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 10 Apr 2018 06:22 |
| Last Modified: | 17 Dec 2018 16:22 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6921 |
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