Using a simplified Downes score to predict the receipt of surfactant in a highly resourced setting

William Chotas; Erika M Edwards; Delia Horn; Roger Soll; Danielle E Y Ehret

doi:10.1038/s41372-024-02086-z

Using a simplified Downes score to predict the receipt of surfactant in a highly resourced setting

J Perinatol. 2024 Aug 5. doi: 10.1038/s41372-024-02086-z. Online ahead of print.

Authors

William Chotas¹, Erika M Edwards^{2

3

4}, Delia Horn², Roger Soll^{2

3}, Danielle E Y Ehret^{2

3}

Affiliations

¹ Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, USA. wchotas@gmail.com.
² Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, USA.
³ Vermont Oxford Network, Burlington, VT, USA.
⁴ University of Vermont College of Engineering and Mathematical Sciences, Burlington, VT, USA.

PMID: 39103471
DOI: 10.1038/s41372-024-02086-z

Abstract

Objective: The Downes score is a neonatal examination scoring tool frequently used to guide initiation of CPAP, but its ability to predict the need for surfactant has not been assessed. We assessed the extent to which the Downes score predicts the receipt of surfactant.

Study design: We calculated a simplified Downes score from nursing admission data for infants (≤ 2000 grams, and ≥ 25 weeks' gestation) admitted on CPAP to a highly resourced level III NICU, to assess the predictive value for the receipt of surfactant.

Results: Fifty-three (31.5%) out of 168 infants admitted on CPAP received surfactant. A simplified Downes score of ≥ 4 predicted the receipt of surfactant with 90.6% sensitivity, 52.2% specificity, 46.6% positive predictive value, 92.3% negative predictive value, and 64.3% accuracy.

Conclusion: The high sensitivity and negative predictive value suggest utility for using the Downes score to help guide clinical decision making regarding surfactant therapy.