Using a Simplified Downes Score to Predict the Receipt of Surfactant in a Highly Resourced Setting

ObjectiveThe 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 designWe 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.ResultsFifty-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.ConclusionThe high sensitivity and negative predictive value suggest utility for using the Downes score to help guide clinical decision making regarding surfactant therapy.