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. 2025 Jan;45(1):30-35.
doi: 10.1038/s41372-024-02086-z. Epub 2024 Aug 5.

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

William Chotas  1 , Erika M Edwards  2   3   4 , Delia Horn  2 , Roger Soll  2   3 , Danielle E Y Ehret  2   3
Affiliations

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

William Chotas et al. J Perinatol. 2025 Jan.

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.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval: The University of Vermont Institutional Review Board determined that this study was not human subjects research. This analysis of existing data was performed in accordance with the Declaration of Helsinki.

Figures

Fig. 1
Fig. 1. Simplification of Downes score.
The Downes score was simplified by: (1) removing the distinction between mild and severe for the presence of retractions, grunting, and decreased air entry; (2) not discriminating between tachypnea ≥ 60 and > 80; and (3) using any FiO2 > 0.21 instead of the presence of cyanosis (FiO2 : fraction of inspired oxygen).
Fig. 2
Fig. 2. Likelihood of receipt of surfactant per simplified Downes score.
The likelihood of receiving surfactant increased as the simplified Downes score increased.
Fig. 3
Fig. 3. ROC Curves for the ability of the simplified Downes score to predict the receipt of surfactant.
The top ROC (A) is without adjustment for gestational age and the bottom (B) is with adjustment for gestational age.
See this image and copyright information in PMC

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