Modification,Reliability,Validity And Assessment Of Neonatal Early Warning Score For Preterm Infants

Objective1.To analysis the items related to early warning indicators for critical/endanger hospitalized preterm infants.2.To modify the Neonatal Early Warming Score?NEWS?for preterm infants and test its reliability and validity,form the MNEWS scale.3.To verify the predictive ability of MNEWS for severity and prognosis in preterm infants compared with NEWS,BPEWS and NCIS scales.Methods1.Based on the literature review,retrospectively investigate the 174 cases of preterm infant which hospitalized in the First Affiliated Hospital of Guangxi Medical University within January to August 2016.Statistical analysis the warming indicators of critical/endanger preterm infants inpatients,and determine items and relevant reference values for initial version of MNEWS.2.Pre-assessed initial version of MNEWS for 25 cases of premature infants in hospital in November 2016.Adjusted the initial version to developmental version and tested its reliability and validity in the 40 cases of premature infant inpatients within January to February 2017.3.Applied developmental version of MNEWS,NEWS,BPEWS,NCIS to assess severity and prognosis of 107 cases of preterm infants,using receiver operator characteristic curve?ROC?to validate the MNEWS predictive ability.Results1.Single and multivariable analysis showed that,iterms suitable for MNEWS scale early warning iterms were Born/Corrected Gestational Age,Weight, Temperature,Heart rate,Respiration,Oxygen saturation?Sp O2?, Consciousness reaction.2.Assigned point values to each items based on the literature review,modified and improved to developmental version.The items included Born/Corrected Gestational Age,Weight,Temperature,Heart rate,Respiration,Blood oxygen,Conscious Reaction of 7 projects.Each item of MNEWS scored 0 to2 points and the total score are 14 points.Analysis of the reliability and validity showed that ICC was 0.906,total Cronbach's a was 0.938,CVR was 0.893,the construct validity factor analysis extracted 2 factors,the cumulative variance contribution rate was 79.640%,the corresponding load of each iterms fromed 2 factors were more than 0.4.3.Using the ROC curve to evaluate MNEWS,NEWS,BPEWS,NCIS scales of predictive ability on severity and prognosis in preterm infants,the results were as follows:On prediction of critical/endanger preterm infants,AURROC of MNEWS was 0.938?sensitivity 92.50%,specificity 83.58%?,the cut-off was 5.On prediction of death,AURROC of MNEWS was 0.704?sensitivity62.50%,specificity 85.29%?,the cut-off was 12.On prediction of supply way of oxygen,the total MNEWS score>3 points and the SpO₂ score>0 points,with a high risk for oxygen supply way of oxygen mixed air;the total MNEWS score>4points and the SpO₂ score?1 points,with a high risk for oxygen supply way of CPAP;the total MNEWS score>7 points and the SpO₂ score=2points,with a high risk for oxygen supply way of respirator ventilation.AURROC of MNEWS,NEWS,BPEWS to predict critical/endanger preterm infants were 0.938,0.883,0.893,MNEWS>BPEWS>NEWS.AURROC of MNEWS,NEWS,BPEWS to predict death of critical/endanger preterm infants were 0.704,0.651,0.688,MNEWS>NEWS>BPEWS.There is a correlation between MNEWS and NCIS?r=-0.691?.Using MNEWS and NCIS scales to predict complications in preterm infants,result showed in NRDS,peripheral circulation,asphyxia,HIE complications,compared the difference of each score before and after,both scales were no statistically significant difference,p>0.05,the predictive ability were high for these complications;in hyperbilirubinemia,there was statistically significant difference,p<0.05,MNEWS predictive ability is worse than NCIS;in hypoglycemia and intracranial hemorrhage,both scales were no statistically significant difference,p>0.05,the predictive ability of both scale in two complications was both low.Conclusions1.The MNEWS scale has high reliability,stability,content and structure validity.It is suitable for assessing preterm infants.2.The predictive ability of MNEWS in critical/endanger preterm infants was mid-high degree.MNEWS scale can be used to identify the children with oxygen supply,and could assist in determining the way of oxygen supply.But the predictive ability of MNEWS of preterm infants was mid-low degree.3.Compared to NEWS,BPEWS,MNEWS has best ability to predict the severity of premature infants.All scales weren't good to predict the death of critical preterm infants.MNEWS has a negative correlation with NCIS,and the higher the total MNEWS score.More serious the illness was,higher the total score was.4.Dynamic MEWS on the first day and the first week can help to identify NRDS,peripheral circulation and apnea,but the effect of dynamic monitoring on anemia,hypoglycemia,jaundice,HIE is not obvious.It does not directly reflect the risk of disease with chronic pathological changes.