STARZ Neonatal Score

STARZ Neonatal AKI Risk Stratification Scoring

The STARZ [Sethi Tibrewal Agarwal Raina waZir] neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit.

Variables Assigned Score
Age at entry in NICU (hours)
PPV in the delivery room
Gestational age (weeks)
Sepsis (during the NICU stay)
Significant cardiac disease
Urine output^ (ml/kg/hr)
Serum creatinine^(mg/dl)
Use of nephrotoxic drugs
Use of furosemide
Use of Inotropes

^First 12 hours post admission in NICU
PPV: Positive pressure ventilation; NICU: Neonatal Intensive Care Unit; hr; hour; ml: millilitre; kg: kilogram; mg: milligram; dl: decilitre

Nephrotoxic drugs included Vancomycin or Colistin or Amphotericin B

We defined significant cardiac disease as hemodynamically significant patent ductus arteriosus [PDA]; persistent pulmonary hypertension of the newborn [PPHN]; cardiogenic shock and other congenital cardiac disease.

The probability of AKI is <20% with a score up to 37, 20–<40% for score 38–42, 40–<60% for score 43–48, 60–<80% for score 49–53, and ≥80% for score ≥54. This scoring model was observed to have a sensitivity of 92.8%, specificity of 87.4%, positive predictive value of 80.5%, negative predictive value of 95.6% and accuracy of 89.4% in the original study.

Reference: Wazir S, Sethi SK, Agarwal G, Tibrewal A, Dhir R, Bajaj N, Gupta NP, Mirgunde S, Sahoo J, Balachandran B, Afzal K, Shrivastava A, Bagla J, Krishnegowda S, Konapur A, Soni K, Rana A, Bunchman T, Raina R. Neonatal acute kidney injury risk stratification score: STARZ study. Pediatr Res. 2021 May 19. doi: 10.1038/s41390-021-01573-9. Epub ahead of print. PMID: 34012029.