Modified Sick Neonatal Score and Delta: Modified Sick Neonatal Scores As Prognostic Indicators in Neonatal Intensive Care Units

Abstract

Background Modified Sick Neonatal Score (MSNS) is a modification of the Sick Neonatal Score (SNS) by adding perinatal factors such as birth weight and gestational age to the scoring. A significantly higher sensitivity and specificity were obtained by adding the above parameters to SNS. The parameters in MSNS were simple and easy to score, but the scoring was done only once, and the utility of the score to assess the response to treatment was not analysed. In this study, we aimed to determine the role of MSNS as a prognostic indicator in the neonatal intensive care unit (NICU) and to study the correlation of the change in the MSNS (Delta-MSNS) 24 hours after admission with the outcomes and as a measure of response to treatment. Methodology A cross-sectional study was conducted for six months on all neonates admitted to the NICU during the study period. All babies were scored using MSNS containing eight basic clinical parameters, namely, respiratory rate, heart rate, axillary temperature, peripheral capillary refill time, random blood sugar, oxygen saturation, gestational age, and birth weight. Scoring by MSNS was done on the following two occasions: first score at admission, and second score 24 hours later. A change in the score during the first 24 hours of NICU stay (Delta-MSNS) was analysed for babies with an initial score of less than or equal to 12. All babies were followed up for analysis of outcomes, and outcomes were documented as discharge from the hospital or death. Length of hospital stay was documented for the babies that were discharged. Statistical analysis was done using the software RStudio v1.1.456. Kruskal-Wallis rank sum test was used to compare individual parameters of the score as well as the mean score between the expired and discharged groups. Spearman rank-order correlation coefficient was used to correlate the scores with length of hospital stay. Results A total of 248 neonates were considered for inclusion in the study. The mean score at admission was 7.94 (SD = 1.89) in the expired group and 14.46 (SD = 1.84) in the discharged group. The p-value for each of these was <0.001. Using MSNS as a test variable, a receiver operating characteristic (ROC) curve was generated, and as measured by the area under the curve was 0.98. A cut-off score of 10 was obtained that had a sensitivity of 88.24%, specificity of 95.2%, positive predictive value of 57.69%, and negative predictive value of 99%. A significant negative correlation was observed with a Spearman correlation coefficient of -0.67 when the initial MSNS was correlated with length of hospital stay in patients who were discharged. A significant negative correlation with a coefficient of -0.39 and p-value of 0.017 was determined when delta MSNS score was correlated with the discharged babies who had an initial score of less than 12. Conclusions MSNS is an easy-to-use bedside scoring system that requires minimal training and no invasive procedures. It has shown a h...

Identification of the Best Predictive Model for Mortality in Outborn Neonates—Retrospective Cohort Study

“…The next step was finding new variables easy to use for the SNS score to improve its ability to predict mortality in all neonatal populations. Lower gestational age and birth weight were repeatedly demonstrated as associated with an increased risk of death; therefore, we used them for the development of a new scoring system, the same as other authors [5,[26][27][28]57]. Gender, early onset sepsis diagnosis, and asphyxia (defined as an Apgar score < 3/1 min) showed no association with mortality (p > 0.05) in our statistics (Table 5).…”

“…All other newborns must be transferred to level III units [31,32]. Our study group included 403 neonates after the exclusion of 15 infants submitted for severe congenital abnormalities, a rather large group of patients compared with most of the studies searching or evaluating a scoring system for the severity of the disease [20,[26][27][28][29][30][41][42][43]. Out of the 403 infants in the study group, 217 were preterm infants (53.8%); 20 of the infants died, the fatality rate being 4.96% (Figure 1).…”

“…It should require minimally invasive procedures, be reproducible, and have a solid ability to predict mortality and specific morbidities. Additionally, it should be able to distinguish between neonates with varying outcomes [21,22,[25][26][27][28]37]. All such scoring systems need accurate validation in reasonably large data sets, calibration, tests for their discrimination capacity (scores with AUC >0.8 are useful in practice), reproducibility, and capacity to avoid biases [25].…”

“…The results are comparable with those using MSNS to predict mortality. Padar et al [26] found that a cut-off value of 10 predicted mortality with a sensitivity of 88.24% and sensibility of 92.5% in 248 neonates evaluated at birth and at 24 h of life. A mean score of 9.11 was found in non-survivors as compared with 12.9 survivors in a group of 71 newborns, of which 80% were term infants in a study published by Reddy and colleagues [27].…”

“…Additionally, there are many organizational differences between national maternal and neonatal care, regionalization, and neonatal transport systems [5,[23][24][25]. An ideal score-or predictive model for the severity of the disease-should be easy, applicable early after admission, needing a minimum of invasive procedures, reproducible, with a good ability to predict mortality and specific morbidities and to discriminate between neonates with different outcomes [9,21,22,[25][26][27][28]. Additionally, these predictions allow better planning and usage of resources of care, improvements of neonatal care before and during transport, cost analysis, evaluation of the care quality, comparisons between neonatal units, research, and parental counseling [22,[25][26][27][28][29].…”