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Birth Score - Guidelines for Completing the Birth Score Form

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GUIDELINES page 2 of 4

III. PROCEDURE FOR SCORING

A.   Begin the screening process in the Labor room or Delivery room.
 

B.   Complete ALL items on the form using blue or black ink. For block responses, clearly print only one number or letter per block.
 

C.   Completely fill bubble responses (● correct response). Do not use check marks or crosses to mark through bubbles.
 

D.   Enter your hospital/birth center three or four digit code in the space at the top of the form marked Delivery Hospital.
 

E.   Complete the Developmental risk section of the form: Any identified Congenital Abnormality or one or more Yes responses noted on the Developmental Risk section of the form indicates the infant is at-risk for Developmental Delay. Any infant identified at-risk for Developmental Delay is an automatic “High Score” baby.

 

F.    Complete and calculate the Birth Score: The total Birth Score will yield either a Low Birth Score or a High Birth Score.

Low Birth Score is a score of 99 or less

High Birth Score is a score of 100 or higher.

 

Check the infant’s risk for Developmental Delay. Remember, an infant at-risk for Developmental Delay is an automatic “High Score” even if the total Birth Score is less than 100.

 

G.   Trained staff must perform the hearing screen test (ABR or OAE).

Mark the type of test used and the test results (pass/fail) on the screening form.

If a hearing screen is not performed, mark the reason.

 

H.   Discuss the outcomes of the three screens with the infant's parent and complete the remaining sections of the form.
 

I.      Complete the “Questions for Mother” section of the form.

Mark on the form any drug use already documented in the mother’s chart. Encourage mother to identify any additional substances used during pregnancy.

Five questions directed toward identification of maternal behaviors/conditions that potentially may affect a baby’s health are included to help identify new information associated with unfavorable infant outcomes.   Encourage mothers to answer.

  1. Drug Use in Pregnancy: In addition to the mother’s response, drug use    already documented in the mother’s medical record should be recorded on the form.

  2. Stress during Pregnancy: Mothers should indicate if they have experienced prolonged periods of stress during their pregnancy.

  3. Diabetes: Mothers should indicate if they have ever been diagnosed by a physician with diabetes. Diabetes already documented in the mother’s medical record should be recorded on the form. 

  4. Self-perceived overall health: Mothers should indicate how their overall health is best described.

  5. Height & Weight:  Height and weight are asked to determine the mother’s body mass index. Height should be self-reported by the mother. Weight should be documented at admission pre-delivery in the medical record.   Weight should not be self-reported.

J. If the baby has any of the following, notify the infant's physician:

High Birth Score

At-risk for Developmental Risk Screen

Hearing Screen failure

 

K.   Call the Birth Score Office at (304) 293-7302 if you have any questions regarding the completion of this form.

IV.  SPECIAL CIRCUMSTANCES:

A.   If baby is transported to another hospital:

  1. Complete as much information as possible.

  2. Send a photocopy of the form to the receiving hospital.

  3. Send the original copy to the Birth Score Office.

  4. Be sure the receiving hospital’s name is written in the section requesting transfer information.
     

B.   If baby is admitted to a NICU or special care unit:

  1. If the baby is admitted to a NICU located within the birth hospital. Mark the appropriate responses on the score card for the question “Was infant transferred to NICU” Complete as much information as possible and forward the score to the NICU with the infant.

  2. If the baby is transported to a NICU located in another hospital.  Mark the appropriate responses on the score card for the question “Was infant transferred to NICU", and process as outlined in A above.
     

C.   If baby dies in-house:

  1. Complete as much information as possible.

  2. Note in space marked "Doctor or Clinic Providing Baby's Care" that baby has died, along with date of death.

  3. Send Original copy to the Birth Score Office.

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