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distress has a high mortality. Downes score is used as an alternative
to evaluate clinical respiratory distress if blood gas analysis
instrument or pulse oxymetry is not available.
Objective To evaluate the validity of Downes score for assessing
hypoxemia in neonates with clinical respiratory distress.
Methods A cross sectional study was carried out on neonates with
clinical respiratory distress hospitalized at level 2 and 3 Neonatal
Care Unit and in Emergency Room of Dr. Sardjito General
Hospital, Yogyakarta. Downes score and oxygen saturation
measured by a pulse oximetry were compared. Hypoxemia was
defined as oxygen saturation less than 90% in term and post-
term infants, less than 88% in preterm neonates, or Downes
score 2:5 according to Basic Emergency Service Training for
Obstetry and Neonatology (PONED) in 2007. The accuracy of
Downes score in predicting hypoxemia was assessed by sensitivity,
specificity, positive-predictive value, negative-predictive value,
and likelihood ratio.
Results Eighty nine neonates were evaluated. Downes score had
sensitivity of 88%, specificity of 81 o/o, positive-predictive value of
72%, negative- predictive value of 92%, positive likelihood ratio
4.53, negative likelihood ratio 0.15, prevalence of 36%, and post
test probability of 72%.
Conclusion Downes score can be used as a clinical diagnostic
means for assessing hypoxemia in clinical respiratory distressed
neonates with 88% sensitivity (95% CI 79 to 99), and specificity
81% sensitivity (95% CI 70 to 91).
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