Neonatal Sequential Organ Failure Assessment Score (nSOFA) as a mortality predictor in late-onset neonatal sepsis

Abstract

Background Neonatal sepsis is a main challenge that neonatologists usually face in the neonatal intensive care unit. We aimed to investigate the ability of the Neonatal Sequential Organ Failure Assessment (nSOFA) score to predict mortality in neonates admitted with late-onset sepsis (LOS). Methods Seventy neonates with LOS were included in the study. A complete blood count, C-reactive protein test, blood culture, and sensitivity were conducted on all babies. All neonates were monitored for their need for mechanical ventilation, oxygen requirements, the need for inotropics and corticosteroids, as well as thrombocytopenia and its degree. All neonates were followed up by the application of the nSOFA score. The nSOFA score was recorded at the onset of signs of sepsis and after 24, 48, and 72 hours. Results The study included 70 infants with LOS, with a median gestational age of 35.5 weeks and a median birth weight of 2.6 kg; 19 infants (27.1%) died. The median total nSOFA score was significantly higher in nonsurvivors compared to survivors on all evaluation days ( P < 0.001). Each of the three components of the nSOFA score was individually higher in nonsurvivors on all days of evaluation, with a progressive increase over time. There was no significant difference in nSOFA scores between neonates with gram-positive and gram-negative organisms. The receiver operating characteristic curve shows that the nSOFA score at presentation has a sensitivity of 84.21 and a specificity of 80.39 for predicting mortality in neonates with LOS at a cutoff point of >6. Conclusion We concluded that nSOFA can be a feasible tool that can help in predicting mortality in neonates with LOS. Future studies with larger sample sizes are needed to validate the use of nSOFA in predicting mortality and other adverse outcomes.