Neonatal stabilization score. A quantitative method of auditing medical care in transported newborns weighing less than 1,000 g at birth

A reduction in newborn (NB) mortality is contingent on efforts of NB stabilization. The authors attempted to quantify stabilization into a score, the neonatal stabilization score (NSS) that correlates with outcome. The population for the study comprised 192 transported NBs who weighed less than 1,000 g at birth moved from level 1 hospitals in New York City during 5 years, 1977-1981. The NSS score was based on five components: vital signs, laboratory investigations, respiratory support, I.V. fluid administration, and specific managements. Each was rated 0, 1, or 2. A maximum score of 10 indicated excellent stabilization. Analyses for the validity and reliability of the NSS included the Mantel-Haenszel test (which controlled for birth weight and Apgar) and measurement of interrater agreement "k" (kappa statistic). Mortality rates were lower in those with higher NSS and odds of death were 2.39 times greater in NB with low NSS (chi 2 = 5.16; P less than 0.025). The calculated index of agreement k on 16 charts represented an excellent agreement beyond chance (k = 0.76, P less than 0.01).