The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

RESPIRATORY ASSESSMENT SCORE FOR NEWBORNS AND THE INCIDENCE OF SURFACTANT ADMINISTRATION

D. Montoto1, M. R. Gomez1


Background: The Respiratory Assessment Score (RAS) has been used by the neonatal transport team at Saint Francis Hospital in Tulsa, Oklahoma for several years. The score is used as a tool to paint a picture of the patient's respiratory condition and to help determine need for intubation. Similar to the APGAR score, the RAS employs a point system for 5 different categories: respiratory rate, oxygen requirement, degree of retractions, quality of breath sounds, and presence of grunting. Each category can score 0, 1 or 2 points for a maximum of 10 points. Unlike the APGAR score, the sickest patients are those that score the highest. There is virtually no cost associated with the score and because it is fast and easy to perform, decisions about treatment can be made quickly which is most beneficial during transport. This study compares the RAS score done within the first 24 hours of life to the incidence of surfactant administration during the patients hospital stay. The purpose of the study is to determine if it is feasible to make decisions on whether to give surfactant based on the RAS score.

Method:
Retrospective data collection was performed for infants transported in 2003 and 2004. Criteria for inclusion were: > 31 weeks gestation, primary diagnosis of respiratory distress, < 24 hours old, never been intubated. Scoring was done when transport team arrived at referral hospital. Two groups of patients were compared: Group 1 included patients that scored a 7 or higher, Group 2 included patients that scored less than 7. There were 32 patients in Group 1 and 33 patients in Group 2 for a total of 65 patients.

Results:
A total of 26 infants in Group 1 received surfactant during their hospital stay compared to 4 infants in Group 2. The odds ratio calculation shows that infants scoring a 7 or more on their RAS score were 31.4 times more likely to receive surfactant than patients scoring less than 7 (confidence interval of 8 to 124). Of the infants in Group 1 that received surfactant, 16 out of the 26 (61.5%) required more than one dose.

Conclusions: The RAS score of 7 or greater appears to be a good marker for making the decision to give surfactant. If early surfactant replacement is more beneficial than late, surfactant should be given as soon as the patient scores a 7 or more.

RESPIRATORY ASSESSMENT SCORE FOR NEWBORNS
  0 1 2
RESPIRATORY RATE < 60 60 - 80 > 80 OR APNEA
O2 REQUIREMENT* 21 - 30% 30 - 40% > 40%
RETRACTIONS NONE MILD MODERATE TO SEVERE
BREATH SOUNDS CLEAR, GOOD AERATION BILATERALLY COARSE WITH GOOD AERATION OR SLIGHT WHEEZING DECREASED, TIGHT OR DIMINISHED
PRESENCE OF GRUNTING NONE OCCASIONAL CONSTANT

*O2 requirment to maintain SpO2 > 89%