A neonatal sequential organ failure assessment score predicts mortality to late-onset sepsis in preterm very low birth weight infants

An operational definition of organ dysfunction applicable to neonates that predicts mortality in the setting of infection is lacking. We determined the utility of an objective, electronic health record (EHR)-automated, neonatal sequential organ failure assessment (nSOFA) score to predict mortality f...

Full description

Saved in:
Bibliographic Details
Published inPediatric research Vol. 88; no. 1; pp. 85 - 90
Main Authors Wynn, James L, Polin, Richard A
Format Journal Article
LanguageEnglish
Published United States Nature Publishing Group 01.07.2020
Subjects
Automation
Birth weight
Mortality
Sepsis
Online AccessGet full text

Cover

More Information
Summary:An operational definition of organ dysfunction applicable to neonates that predicts mortality in the setting of infection is lacking. We determined the utility of an objective, electronic health record (EHR)-automated, neonatal sequential organ failure assessment (nSOFA) score to predict mortality from late-onset sepsis (LOS) in premature, very low birth weight (VLBW) infants. Retrospective, single-center study of bacteremic preterm VLBW newborns admitted between 2012 and 2016. nSOFA scores were derived for patients with LOS at multiple time points surrounding the sepsis evaluation. nSOFA scores at evaluation and at all points measured after evaluation were different between survivors and non-survivors. Among patients with an nSOFA score of >4, mortality was higher at evaluation (13% vs 67%, p < 0.001), +6 h (15% vs 64%, p = 0.002), and +12 h (7% vs 71%, p < 0.001) as compared to patients with a score of ≤4. Receiver operating characteristics area under the curve was 0.77 at evaluation (95% CI 0.62-0.92; p = 0.001), 0.78 at +6 h (0.66-0.92; p < 0.001), and 0.93 at +12 h (0.86-0.997; p < 0.001). The nSOFA scoring system predicted mortality in VLBW infants with LOS and this automated system was integrated into our EHR. Prediction of LOS mortality is a critical step toward improvements in neonatal sepsis outcomes.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
Author contributorship statement
Dr. Wynn performed all aspects of the study. Dr. Polin contributed to the development of the nSOFA score and edited the manuscript. The distinction of infection from sepsis is not widely recognized in the NICU. The definition of sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. The presence of life-threatening organ dysfunction is demonstrated using a sequential organ failure assessment (SOFA) to determine risk of ICU admission or mortality.To define sepsis in neonates therefore requires an operational definition of organ dysfunction applicable specifically to this population (neonatal SOFA; nSOFA) that predicts mortality in the setting of presumed infection.We determined the utility of an objective, electronic health record (EHR)-automated, neonatal sequential organ failure assessment (nSOFA) score to predict mortality from late-onset sepsis (LOS) in premature, very low birth weight (VLBW) infants.We developed and tested an objective, electronic health record (EHR)-automated, nSOFA scoring system to predict mortality from LOS in premature, very low birth weight infants at our center.The nSOFA has strong potential to serve as an objective operational definition of organ dysfunction applicable to this unique population that can align neonatal sepsis investigators globally, allow longitudinal disease stratification including prognostication, and facilitate predictive enrichment for future prospective interventional clinical trials.
ISSN:0031-3998
1530-0447
DOI:10.1038/s41390-019-0517-2