Neonatal Early Warning Tools for recognising and responding to clinical deterioration in neonates cared for in the maternity setting: A retrospective case–control study

Michelle Paliwoda, Karen New, Fiona Bogossian

Research output: Contribution to journalArticleResearchpeer-review

8 Citations (Scopus)


Background All newborns are at risk of deterioration as a result of failing to make the transition to extra uterine life. Signs of deterioration can be subtle and easily missed. It has been postulated that the use of an Early Warning Tool may assist clinicians in recognising and responding to signs of deterioration earlier in neonates, thereby preventing a serious adverse event. Objective To examine whether observations from a Standard Observation Tool, applied to three neonatal Early Warning Tools, would hypothetically trigger an escalation of care more frequently than actual escalation of care using the Standard Observation Tool. Design A retrospective case–control study. Setting A maternity unit in a tertiary public hospital in Australia. Methods Neonates born in 2013 of greater than or equal to 34+0 weeks gestation, admitted directly to the maternity ward from their birthing location and whose subsequent deterioration required admission to the neonatal unit, were identified as cases from databases of the study hospital. Each case was matched with three controls, inborn during the same period and who did not experience deterioration and neonatal unit admission. Clinical and physiological data recorded on a Standard Observation Tool, from time of admission to the maternity ward, for cases and controls were charted onto each of three Early Warning Tools. The primary outcome was whether the tool ‘triggered an escalation of care’. Descriptive statistics (n, %, Mean and SD) were employed. Results Cases (n = 26) comprised late preterm, early term and post-term neonates and matched by gestational age group with 3 controls (n = 78). Overall, the Standard Observation Tool triggered an escalation of care for 92.3% of cases compared to the Early Warning Tools; New South Wales Health 80.8%, United Kingdom Newborn Early Warning Chart 57.7% and The Australian Capital Territory Neonatal Early Warning Score 11.5%. Subgroup analysis by gestational age found differences between the tools in hypothetically triggering an escalation of care. Conclusions The Standard Observation Tool triggered an escalation of care more frequently than the Early Warning Tools, which may be as a result of behavioural data captured on the Standard Observation Tool and escalated, which could not be on the Early Warning Tools. Findings demonstrate that a single tool applied to all gestational age ranges may not be effective in identifying early deterioration or may over trigger an escalation of care. Further research is required into the sensitivity and specificity of Early Warning Tools in neonatal sub-populations.

Original languageEnglish
Pages (from-to)125-135
Number of pages11
JournalInternational Journal of Nursing Studies
Publication statusPublished - 1 Sept 2016
Externally publishedYes


  • Early warning score
  • Early Warning Tool
  • Maternity newborn care
  • Neonate
  • Newborn

Cite this