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GUIDELINES page 2 of 4
III. PROCEDURE FOR SCORING
Begin the screening process in the Labor room or Delivery room.
Complete ALL items on the form using blue or black ink. For
block responses, clearly print only one number or letter per block.
Completely fill bubble responses
(● correct response). Do not use check marks or crosses to mark through
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.
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.
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:
B. If baby is admitted to a NICU or special care unit:
C. If baby dies in-house:
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