Downes score as a clinical assessment for hypoxemia in neonates with respiratory distress
Keywords:
Downes score, neonates, hypoxemia, respiratory distress
Abstract
Background Hypoxemia in neonates with clinical respiratorydistress 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).
References
1. Mathai SS, Raju U, Kanitkar M. Management of respiratory
distress in the newborn. MJAFI. 2007;63:269-72.
2. Duke T, Blaschke AJ, Sialis S, Bonkowsky JL. Hypoxaemia in
acute respiratory and in non-respiratory illnesses in neonates
and children in a developing country. Arch Dis Child.
2002;86: 108-12.
3. Onyango FE, Steinhoff MC, Wariua S, Musia J, Kitonyi J.
Hypoxemia in young children with acute lower respiratory
infection. BMJ. 1993;306:612-15.
4. Jennis MS, Peabody JL. Pulse oximetry : an alternative
method for the assessment of oxygenation in newborn.
Pediatrics. 1985; 79 ( 4) :5 24-7.
5. Hay WW, Brockway J, Eyzaguirre. Neonatal pulse oximetry:
accuracy and reliability. Pediatrics. 1989;83:717-22.
6. Lee WW, Mayberry K, Crapo R, Jensen RL. The accuracy of
pulse oximetry in the emergency department. Am J Emerg
Med. 2000;18(4):427-31.
7. Basnet, S, Adhikari R, Gurung C. Hypoxemia in childrenwith
pneumonia and its clinical predictors. Indian J Pediatr.
2006; 73 (9): 777-81.
8. Lodha R, Bhadauria P, Kuttikat A,Puranik M, Gupta S, Pan-
dey RM, Kabra SK. Can clinical symptoms or signs accurately
predict hypoxemia in children with acute lower respiratory
tract infections. Indian Pediatrics. 2004;41: 129-35.
9. Usen S, Webert M, Mulholland K. Clinical predictors of
hypoxemia in Gambian children with acute lower respiratory
tract infection: prospective cohort study. BMJ. 1999;318: 86-91.
10. Aly H. Neonatal respiratory disorder. In: USAID Indonesia,
HSP, Departemen Kesehatan RI, IDAI. Principles of
basic neonatal care training course. Jakarta: Departemen
Kesehatan; 2006.
11. PONED. Pelatihan Pelayanan Obstetri dan Neonatal
Emergensi Dasar. Jakarta: Departemen Kesehatan; 2007.
12. Downes JJ, Vidyasagar D, Morrow GM, Boggs TR. Respi-
ratory distress syndrome of newborn infant. Clin Pediatr.
1970;9(6):325-31.
13. Russian Federation-United States of America. (Re) Designing
the system of care for neonates suffering from respiratory
distress syndrome. Russia: The USA-Russia Joint Commission
on Economic and Technological Cooperation; 2001.
distress in the newborn. MJAFI. 2007;63:269-72.
2. Duke T, Blaschke AJ, Sialis S, Bonkowsky JL. Hypoxaemia in
acute respiratory and in non-respiratory illnesses in neonates
and children in a developing country. Arch Dis Child.
2002;86: 108-12.
3. Onyango FE, Steinhoff MC, Wariua S, Musia J, Kitonyi J.
Hypoxemia in young children with acute lower respiratory
infection. BMJ. 1993;306:612-15.
4. Jennis MS, Peabody JL. Pulse oximetry : an alternative
method for the assessment of oxygenation in newborn.
Pediatrics. 1985; 79 ( 4) :5 24-7.
5. Hay WW, Brockway J, Eyzaguirre. Neonatal pulse oximetry:
accuracy and reliability. Pediatrics. 1989;83:717-22.
6. Lee WW, Mayberry K, Crapo R, Jensen RL. The accuracy of
pulse oximetry in the emergency department. Am J Emerg
Med. 2000;18(4):427-31.
7. Basnet, S, Adhikari R, Gurung C. Hypoxemia in childrenwith
pneumonia and its clinical predictors. Indian J Pediatr.
2006; 73 (9): 777-81.
8. Lodha R, Bhadauria P, Kuttikat A,Puranik M, Gupta S, Pan-
dey RM, Kabra SK. Can clinical symptoms or signs accurately
predict hypoxemia in children with acute lower respiratory
tract infections. Indian Pediatrics. 2004;41: 129-35.
9. Usen S, Webert M, Mulholland K. Clinical predictors of
hypoxemia in Gambian children with acute lower respiratory
tract infection: prospective cohort study. BMJ. 1999;318: 86-91.
10. Aly H. Neonatal respiratory disorder. In: USAID Indonesia,
HSP, Departemen Kesehatan RI, IDAI. Principles of
basic neonatal care training course. Jakarta: Departemen
Kesehatan; 2006.
11. PONED. Pelatihan Pelayanan Obstetri dan Neonatal
Emergensi Dasar. Jakarta: Departemen Kesehatan; 2007.
12. Downes JJ, Vidyasagar D, Morrow GM, Boggs TR. Respi-
ratory distress syndrome of newborn infant. Clin Pediatr.
1970;9(6):325-31.
13. Russian Federation-United States of America. (Re) Designing
the system of care for neonates suffering from respiratory
distress syndrome. Russia: The USA-Russia Joint Commission
on Economic and Technological Cooperation; 2001.
Published
2016-09-15
How to Cite
1.
Rusmawati A, Haksari E, Naning R. Downes score as a clinical assessment for hypoxemia in neonates with respiratory distress. PI [Internet]. 15Sep.2016 [cited 20Apr.2024];48(6):342-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/626
Section
Articles
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Received 2016-09-14
Accepted 2016-09-14
Published 2016-09-15
Accepted 2016-09-14
Published 2016-09-15
