Use of the laboratory in prediction of outcome in the high-risk newborn.

This paper reviews our ability to predict survival and neurodevelopmental outcome in the newborn period. Traditionally, prognosis is based on individual risk factors or disease states. The laboratory plays an important role in diagnosing some of these. For example, prenatal and newborn screening are important in the diagnosis of chromosomal abnormalities and inborn errors of metabolism. Abnormal bilirubin, glucose, and pH values in the newborn period are risk factors for death and abnormal neurodevelopment, and the degree of abnormality imparts additional information. Many newborns have multisystem disorders, and it is only when multiple variables are considered that outcome can be predicted. Three neonatal scores that incorporate multiple variables are discussed. Methodologic difficulties in determining outcome are reviewed and illustrated with survival and morbidity rates of very premature babies. The laboratory is one of many prognostic variables. The evaluation of how laboratory services are provided is difficult but important.