| Objective:To analyze the application effect of the modified neonatal early warning score in the condition and prognosis evaluation of premature infants.Methods:Ninety premature infants admitted to the Department of Neonatology in our hospital from January 2017 to June 2017 were selected,including 27 critically ill infants and 63 non-critically ill infants.Based on the concept of evidence-based medicine,this study preliminarily determined 14 scoring items by referring to various versions of scoring scales,combined with the actual situation of our hospital,and screened these 14 items by single-factor and multi-factor statistical analysis method.Seven items were screened out,and the range of preliminary reference values was optimized.The final modified neonatal early warning score(MNEWS)for preterm infants was obtained by reliability and validity analysis.All premature infants completed the data collection of MNEWS,NEWS,BPEWS and NCIS within 3 hours.Before application,in order to guarantee the consistency and rationality of the scoring,it is necessary to carry out systematic training for medical staff,mainly including the connotation of the scoring tables,evaluation methods,evaluation criteria and unified measurement tools.The ROC,which is accepted as the best accuracy of evaluation and diagnosis test,is used as a measure of the predictive effectiveness.Analyze the effectiveness of MNEWS in evaluating the condition and prognosis of premature infants.Compare the discrimination of MNEWS,NEWS,BPEWS and NCIS in evaluating the condition and prognosis of premature infants.Results:(1)The MNEWS of very early preterm infants was(12.35±1.16),higher than that of early preterm infants(7.36±3.18)(P<0.05);and higher than that of late preterm infants(4.14±2.05)(P<0.05).(2)The best diagnostic threshold of MNEWS for predicting the severity was 5 points,and its AUROC was 0.983,the sensitivity and specificity were 92.50%and 83.58%.(3)The best diagnostic threshold of MNEWS for predicting mortality was 12 points,and its AUROC was 0.704,the sensitivity and specificity were 37.50%and 85.29%.(4)The best diagnostic threshold of MNEWS for predicting the ventilator oxygen supply was 7 points,the AUROC was 0.993,the sensitivity and specificity were 94.12%and 96.67%,respectively.The best diagnostic threshold of MNEWS for predicting the CPAP oxygen supply was 4points,the AUROC was 0.822,the sensitivity and specificity were 100.00%and76.29%,respectively.The best diagnostic threshold of MNEWS for predicting the air-oxygen supply was 3 points,the AUROC was 0.731,the sensitivity and specificity were 100.00%and 67.35%,respectively.(5)For NRDS,peripheral circulation dysfunction,asphyxia and HIE,the difference between MNEWS and NCIS was not statistically significant(P>0.05).For hyperbilirubinemia,MNEWS was lower than NCIS(P<0.05).For hypoglycemia and intracranial hemorrhage,MNEWS and NCIS was not statistically significant(P>0.05).(6)The best diagnostic thresholds of MNEWS,NEWS and BPEWS for evaluating the condition of premature infants are 5,3 and 2,and the AUROC values are 0.938,0.893 and 0.883,respectively.(7)The best diagnostic thresholds of MNEWS,NEWS and BPEWS for predicting premature infant mortality were 12,6 and 3,and the AUROC values were 0.704,0.651 and0.688,respectively.(8)There is a negative correlation between MNEWS and NCIS scales in predicting the severity of premature infants(R~2=0.478,r=-0.691,P<0.05).Conclusion:(1)MNEWS has a high predictive effect on the condition evaluation of premature infants.(2)MNEWS scale has a high resolution for the evaluation of ventilator oxygen supply,CPAP oxygen supply and air-oxygen mixed oxygen supply.(3)MNEWS and NCIS have good predictive effect on complications of NRDS,peripheral circulation dysfunction,asphyxia,HIE.For hyperbilirubinemia MNEWS is lower than NCIS.For hypoglycemia and intracranial hemorrhage,MNEWS and NCIS have poor predictive effect.(4)MNEWS,BPEWS and NEWS have certain application value in the condition and prognosis evaluation.The AUROC of MNEWS is the highest.Because MNEWS includes such indicators as gestational age and birth weight of premature infants,and the reference range is optimized,which is more in line with the physiological characteristics of premature infants.(5)There was a negative correlation between MNEWS and NCIS.NCIS includes not only clinical signs,but also physiological and biochemical indicators,its evaluation is more comprehensive.However,MNEWS only takes 10 minutes,while the NCIS takes at least 2 hours,and the cost of MNEWS is lower.Therefore,MNEWS tool is more suitable for rapid assessment of the condition of premature infants. |
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