Assessment of Neonates with Extended Sick Neonate Score (ESNS) for Predicting Mortality in a Tertiary Care Center in Dharwad, Karnataka, India: A Prospective Cohort Study

Abstract

Introduction: High neonatal mortality rates may be attributed to the lack of early recognition of severe illness, early and safe referral, and proper care. Therefore, there is a need to develop a simple, cost-effective scoring system that can be quickly applied to newborns referred from peripheral to tertiary care settings in resource-constrained areas. The Extended Sick Neonate Score (ESNS) is one such scoring system used to assess the severity of illness in critically ill neonates and predict their outcomes. Aim: To evaluate the effectiveness of the Extended Sick Newborn Score in predicting outcomes for neonates admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care centre. Materials and Methods: This prospective cohort study included 122 outborn neonates admitted to the NICU of SDM College of Medical Sciences and Hospital in Dharwad, Karnataka, India, from June 2021 to June 2022. All the required parameters for scoring, such as respiratory effort, heart rate, mean blood pressure, axillary temperature, capillary filling time, random blood sugar, SpO2, Moro reflex, and modified Downe’s score, were assessed and documented in a predesigned proforma. The ESNS was calculated upon admission to predict the outcomes. Statistical analysis included ANOVA test and independent t-test, using SPSS version 17.0 and MS Excel. Results: The study evaluated a total of 122 neonates, including 78 males and 44 females. Of these, 99 were term neonates and 23 were preterm neonates. The mean age for term neonates was 8.5 days ±8.6, and for preterm neonates, it was 4.1 days ±4.3. Term neonates with an ESNS Score ≤11 exhibited higher mortality, while preterm neonates with an ESNS score ≤12 showed higher mortality. The sensitivity and specificity of the ESNS score in predicting death were 78.57% and 99.07%, respectively. The ESNS score at admission was significantly lower in non-survivors compared to survivors, and it demonstrated a positive correlation with the outcome. Conclusion: This study found a significant correlation between the ESNS score at admission and in-hospital mortality. The use of the ESNS score is an acceptable method for risk stratification and prognosis of newborns in the NICU.