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

Abstract

ObjectiveAn 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.MethodsRetrospective, single-center study of bacteremic preterm VLBW newborns admitted between 2012–2016. nSOFA scores were derived for patients with LOS at multiple timepoints surrounding the sepsis evaluation.ResultsnSOFA 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 hours (15% vs 64%, p=0.002), and +12 hours (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 +6hrs (0.66–0.92; p<0.001) and 0.93 at +12 hrs (0.86–0.997; p<0.001).ConclusionsThe 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 towards improvements in neonatal sepsis outcomes.