Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Preterm Infants with Necrotizing Enterocolitis

Abstract

<b><i>Introduction:</i></b> The neonatal sequential organ failure assessment (nSOFA) score is a tool for calculating mortality risk of infants in the neonatal intensive care unit. The utility of the nSOFA in determining the risk of mortality or the association with surgical intervention among infants with necrotizing enterocolitis (NEC) has not been investigated. <b><i>Methods:</i></b> We performed a retrospective, cohort study of preterm (<37 weeks) infants with NEC Bell’s stage ≥ IIA at six hospitals from 2008 to 2020. An nSOFA score (range 0–15) was assigned to each patient at nine time points from 48 h before or after clinical illness was suspected. <b><i>Results:</i></b> Of the 259 infants, nSOFA scores for infants who died (<i>n</i> = 39) or had the composite outcome of surgery or death (<i>n</i> = 114) were significantly higher (<i>p</i> < 0.05) early in the NEC course compared to nSOFA scores for infants who survived medical NEC. Twelve hours after evaluation, the area under the receiver operating characteristic curve was 0.87 (95% confidence interval [CI], 0.80–0.93) to discriminate for mortality and 0.84 (95% CI, 0.79–0.90) for surgery or death (<i>p</i> < 0.001). A maximum nSOFA score of ≥4 at −6, 0, 6, or 12 h following evaluation was associated with a 20-fold increase in mortality and 19-fold increase in surgery or death compared with a score of <4 (<i>p <</i> 0<i>.</i>001). <b><i>Conclusion:</i></b> In this multicenter cohort, the nSOFA score was able to discriminate well for death as well as surgery or death among infants with NEC. The nSOFA is a clinical research tool that may be used in infants with NEC to improve classification by objective quantification of organ dysfunction.

Neonatal Sequential Organ Failure Assessment (nSOFA) Score within 72 Hours after Birth Reliably Predicts Mortality and Serious Morbidity in Very Preterm Infants

“…The neonatal SOFA (nSOFA) has been shown to predict the mortality of very preterm infants with late onset sepsis confirmed by blood culture findings [ 7 ]. In the recent large multicenter cohort of preterm patients with necrotizing enterocolitis (NEC), increased nSOFA scores predicted death or need for surgery [ 8 ]. Although other morbidities (early onset sepsis) may be more complex for organ dysfunction assessment, nSOFA can provide a standardized scoring algorithm related to mortality and/or morbidity in preterm infants [ 6 , 7 ].…”

Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Neonates with Respiratory Distress Syndrome: A Retrospective Cohort Study

“…Infection and in ammation has been identi ed as a risk factor for RDS [5] and Nupponen I et al showed that neutrophils were activated in neonates with RDS [6]. The nSOFA score is an operational de nition of organ dysfunction that can identify those preterm neonates with infection and sepsis and an increased risk of mortality [9,10], as sepsis is associated with a systemic in ammatory response which is implicated in the occurrence and development of RDS [6,20]. This study showed that the nSOFA score was strongly predictive of the mortality in neonates with RDS.…”

“…This study lled a gap in this eld, by determining the predictive power of the nSOFA score for mortality in RDS patients and its use to identify RDS patients at increased risk of adverse outcomes. As an objective measure of clinical course, nSOFA score has a potential utility both as a proxy variable for disease severity and as a risk assessment indicator for short-and long-term clinical endpoints [9]. In this study, the nSOFA score showed good correlation in most cases and its ndings will be useful for clinicians and researchers who need tools to objectively measure the risk of death, as well as for healthcare leaders and policy makers who develop resource allocation protocols for critically ill patients [24].…”

“…(3) the presence and severity of thrombocytopenia based on the most recent platelet measure scored zero to three [9] (Table 1). Abbreviations: nSOFA: feonatal sequential organ failure assessment; FiO 2 : fraction of inspiratory oxygen; SpO 2 : peripheral oximetric saturation.…”

“…The neonatal sequential organ failure assessment (nSOFA) scoring system is an operational de nition of organ dysfunction, which is widely used to identify the presence of life-threatening organ dysfunction among preterm infants with in ammation-related diseases such as infection and sepsis [9,10].…”