Step 1 - Choose only one across both sections below
Diagnosis (Pre-op)
31
Select the single best match - or leave blank if post-op applies
S/p Cath / Surgery (Post-op)
310
Select the single best match - or leave blank if pre-op applies
Step 2 - Check all that apply
Surgical complexity / stress (if surgery in prior 1 week)
31
Abnormal Echo findings
31
Corrected gestational age
Perfusion & hemodynamic history
Recent episode of poor perfusion in prior 3-4 days?Significant hypotension, lactic acidosis, increased vasoactive support
Comorbidities & risk modifiers
Chromosomal abnormality?Trisomy 21, 22q11.2 deletion
History of recent blood transfusions?>1 in past 5 days
LBW / SGA / IUGR (<2500 g)?Only if <3 weeks old
Maternal risk factors?Substance abuse, infection - only if <3 weeks old
On anti-platelet or anticoagulation regimen?ASA, Plavix, Lovenox, Heparin - subtracts 1 point
Step 3 - Imaging findings
Imaging / clinical finding statusPositive XR: pneumatosis or portal venous gas on KUB/cross-table lateral. Automatic positive: gross hematochezia
Result
0
total pts
Low risk
Score = 0 points
Recommended management
Negative / equivocal imaging
NPO 24h, KUB x1
Positive imaging / gross hematochezia
NPO + Zosyn x5 days, 2-view AXR Q24H x48h
Other management points
1. Suspected positive hemoccult must be verified in lab using FOBT.
2. Positive FOBT can trigger the algorithm, but repeat FOBT is not recommended unless new concern arises.
3. Persistent gross hematochezia at conclusion of treatment requires further evaluation before stopping antibiotics.
4. Resume feeds at end of treatment with no further imaging unless clinical evidence of persistent ischemia.
5. If penicillin allergy: use Cefepime + Flagyl instead of Zosyn.
1. Suspected positive hemoccult must be verified in lab using FOBT.
2. Positive FOBT can trigger the algorithm, but repeat FOBT is not recommended unless new concern arises.
3. Persistent gross hematochezia at conclusion of treatment requires further evaluation before stopping antibiotics.
4. Resume feeds at end of treatment with no further imaging unless clinical evidence of persistent ischemia.
5. If penicillin allergy: use Cefepime + Flagyl instead of Zosyn.