Neonatal Critical Illness Score Research Articles

Comparing different scoring systems for predicting mortality risk in preterm infants: a systematic review and network meta-analysis.

This study aimed to compare the predictive values of eight scoring systems (Neonatal Critical Illness Score [NCIS], Neonatal Therapeutical Intervention Score System [NTISS], Clinical Risk Index for Babies [CRIB], Clinical Risk Index for Babies II [CRIB-II], Score for Neonatal Acute Physiology Perinatal Extension [SNAPPE], Score for Neonatal Acute Physiology Perinatal Extension II [SNAPPE-II], Score for Neonatal Acute Physiology [SNAP], and Score for Neonatal Acute Physiology II [SNAP-II]) for the mortality risk among preterm infants. The Embase, PubMed, Chinese Biomedical Database, Web of Science, and Cochrane Library databases were searched to collect studies that compared different scoring systems in predicting the mortality risk in preterm infants from database inception to March 2023. Literature screening, data extraction, and bias risk assessment were independently conducted by two researchers. Subsequently, the random-effects model was used for the network meta-analysis. A total of 19 articles were included, comprising 14,377 preterm infants and 8 scoring systems. Compared to CRIB-II, NCIS, NTISS, SNAP-II, and SNAPPE-II, CRIB demonstrated better predictive efficiency for preterm infant mortality risk (P < 0.05). Relative to CRIB, CRIB-II, and SNAPPE, SNAP-II had worse predictive efficiency for preterm infant mortality risk (P < 0.05). The surface under the cumulative ranking curve of the eight scoring systems was as follows: CRIB (0.980) > SNAPPE (0.718) >SNAP (0.534) >CRIB-II (0.525) >NTISS (0.478) >NCIS (0.422) >SNAPPE-II (0.298) >SNAP-II (0.046). The CRIB scoring system showed the highest accuracy in predicting preterm infant mortality risk and was simple to perform. Therefore, CRIB selection can be prioritized in clinical practice. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=434731, PROSPERO (CRD42023434731).

Real-life effects, complications, and outcomes in 39 critically ill neonates receiving continuous kidney replacement therapy.

Continuous kidney replacement therapy (CKRT) has been expanded from simple kidney replacement therapy to the field of critical illness in children. However, CKRT is rarely used in critically ill neonates in the neonatal intensive care unit (NICU). This study aimed to describe patients' clinical characteristics at admission and CKRT initiation, CKRT effects, short-term outcomes, and predictors of death in critically ill neonates. A 7-year single-center retrospective study in a tertiary NICU. Thirty-nine critically ill neonates received CKRT between May 2015 and April 2022 with a mortality rate of 35.9%. The most common primary diagnosis was neonatal sepsis in 15 cases (38.5%). Continuous veno-venous hemodiafiltration and continuous veno-venous hemofiltration were applied in 43.6% and 56.4% of neonates, respectively. The duration of CKRT was 44 (18, 72) h. Thirty-one patients (79.5%) had complications due to CKRT-related adverse events, and the most common complication was thrombocytopenia. Approximately 12h after the CKRT initiation, urine volume, mean arterial pressure, and pH were increased, and serum creatinine, blood urea nitrogen, and blood lactate were decreased. In the multivariate logistic regression analysis, neonatal critical illness score [odds ratio 0.886 (0.786 ~ 0.998), P = 0.046] was an independent risk factor for death in critically ill neonates who received CKRT. CKRT can be an effective and feasible technique in critically ill neonates, but the overall mortality and CKRT-related complications are relatively high. Furthermore, the probability of death is greater among neonates with greater severity of illness at CKRT initiation. A higher resolution version of the Graphical abstract is available as Supplementary information.

Value of Serum miR-34a and Ang-1 in Severity Evaluation and Prognosis of Neonatal Respiratory Distress Syndrome.

Methods A total of 96 neonates with RDS admitted to the hospital from February 2020 to April 2021 were selected as the research subjects. According to the neonatal critical illness score, the subjects were divided into non-critical group (n = 50), critical group (n = 27), and extremely critical group (n = 19). According to survival status, the subjects were divided into survival group (n = 76) and death group (n = 20). Serum miR-34a and Ang-1 levels and NCIS were compared between RDS neonates with different severity and prognosis. The predictive value of serum miR-34a, Ang-1, and NCIS for death was analyzed using the receiver operating characteristic (ROC) curve. Results Serum miR-34a and Ang-1 levels and NCIS were significantly different in the 3 groups (P < 0.05). Serum miR-34a level decreased in order, while serum Ang-1 level and NCIS increased in order from the extremely critical group, the critical group to the non-critical group (P < 0.05). The survival group had lower serum miR-34a level and higher Ang-1 level and NCIS than the death group (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) values of serum miR-34a, Ang-1, and NCIS to predict death of RDS neonates were 0.745, 0.7667, and 0.736. The cutoff values were 1.175, 6.815 ng/mL, and 85 points. The AUC of joint prediction with the three was 0.924, significantly larger than that of each index. The sensitivity and specificity were 94.70% and 90.00%. Conclusion Serum miR-34a, Ang-1, and NCIS are closely related to the severity and prognosis of neonatal RDS. Combined detection of the three is helpful for prognosis of neonatal RDS.

Comparison of different neonatal illness severity scores in predicting mortality risk of extremely low birth weight infants.

To compare different illness severity scores in predicting mortality risk of extremely low birth weight infants (ELBWI). From January 1st, 2019 to January 1st, 2020, all ELBWI admitted in the Children's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital and the First Affiliated Hospital of Nanjing Medical University were included in the study. ELBWI with admission age ≥1 h, gestational age ≥37 weeks and incomplete data required for scoring were excluded. The clinical data were collected, neonatal critical illness score (NCIS), score for neonatal acute physiology version Ⅱ (SNAP-Ⅱ), simplified version of the score for neonatal acute physiology perinatal extension (SNAPPE-Ⅱ), clinical risk index for babies (CRIB) and CRIB-Ⅱ were calculated. The scores of the fatal group and the survival group were compared, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above illness severity scores for the mortality risk of ELBWI. Pearson correlation analysis was used to analyze the correlation between illness scores and birth weight, illness scores and gestational age. A total of 192 ELBWI were finally included, of whom 114 cases survived (survival group) and 78 cases died (fatal group). There were significant differences in birth weight, gestational age and Apgar scores between fatal group and survival group (all <0.01). There were significant differences in NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ between fatal group and survival group (all <0.01). The CRIB had a relatively higher predictive value for the mortality risk. Its area under the ROC curve (AUC) was 0.787, the sensitivity was 0.678, the specificity was 0.804, and the Youden index was 0.482. The scores of NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ were significantly correlated with birth weight and gestational age (all <0.05). The correlation coefficients of CRIB-Ⅱ and CRIB with birth weight and gestational age were relatively large, and the correlations coefficients of NCIS with birth weight and gestational age were the smallest (0.191 and 0.244, respectively). Among these five illness severity scores, CRIB has better predictive value for the mortality risk in ELBWI. NCIS, which is widely used in China, has relatively lower sensitivity and specificity, and needs to be further revised.

Prediction of Bronchopulmonary Dysplasia in Preterm Infants Using Postnatal Risk Factors.

Objective: To identify postnatal risk factors for bronchopulmonary dysplasia (BPD) development in preterm infants with gestational age ≤32 weeks.Methods: Seventy-two preterm infants(30 with BPD and 42 non-BPD controls) admitted in the neonatal intensive care unit (NICU) of the Children's Hospital of Soochow University during 2017 were enrolled in this prospective longitudinal study. Perinatal clinical data, a neonatal critical illness score (NCIS), different soluble B7-H3(sB7-H3), and interleukin-18 (IL-18) levels by days after birth were collected. An early predictive model for BPD development was established based on clinical data using multiple logistic regression analysis. And the sensitivity and specificity of the model were assesed by ROC curve.Results: Electrolyte disturbances, hemodynamically significant patent ductus arteriosus (hs-PDA), and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth were found to be associated with the BPD pathogenesis. Serum sB7-H3, IL-18, and NCIS were significantly higher in the BPD group compared to the non-BPD group (p < 0.05). BPD group had significantly lower enteral fluid and caloric intake compared to the non-BPD group at 1, 7, 14, and 28 days after birth. The risk factors were analyzed by multiple logistic regression and a predictive model of a combination of sB7-H3 (day 7), IL-18 (day 14), NCIS, and clinical risk factors was evaluated via ROC curve with an area under the curve (AUC) of 0.960 having sensitivity of 86.7% and a specificity of 97.6%, respectively.Conclusion: The causes of BPD are multifactorial postnatal risk factors. And the combination of sB7-H3 (day 7), IL-18 (day 14), NCIS, and clinical risk factors (electrolyte disturbances, hs-PDA, and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth) might be served as an optimal predictive model for the occurrence of BPD.

Value of procalcitonin in predicting the severity and prognosis of neonates with septicemia

Objective: To explore the value of procalcitonin(PCT) in predicting the severity and prognosis of neonates with septicemia. Methods: The clinical data of the hospitalized neonates over the age of 72 hours with double positive blood cultures from December 1st, 2011 to September 30, 2017 at the neonatal intensive care unit of Children's Hospital Affiliated to Capital Institute of Pediatrics was analyzed retrospectively. Results: A total of 75 neonates were included in the study. There was a significant negative correlation between PCT and neonatal critical illness score (r=-0.440, P<0.05). Among the groups of non-critical, critical and extremely critical, the levels of PCT had significant difference [0.27(0.10-2.55), 4.34(1.24-20.32), 19.49(1.92-106.49)μg/L, H=20.717, P<0.01]. At a cut-off point of 0.56 μg/L, PCT showed 88.6% sensitivity and 61.3% specificity for critical group diagnosis, with optimal area under the curve of 0.804 (P<0.05). At a cut-off point of 11.45 μg/L, PCT showed 65.2% sensitivity and 82.7% specificity for extremely critical group diagnosis, with optimal area under the curve of 0.735 (P<0.05). Among the groups of none organ dysfunction, single organ dysfunction and shock or multiple organ dysfunction, the levels of PCT had significant difference[0.10(0.43-2.56), 3.18(0.67-20.95), 18.97(1.92-82.90) μg/L, H=20.299, P<0.01]. At a cut-off point of 2.64 μg/L, PCT showed 70.0% sensitivity and 77.1% specificity for single organ dysfunction diagnosis, with optimal area under the curve of 0.793 (P<0.05). At a cut-off point of 9.06 μg/L, PCT showed 61.3% sensitivity and 86.4% specificity for shock or multiple organ dysfunction diagnosis, with optimal area under the curve of 0.782 (P<0.05). PCT levels were significantly higher in the death group than the survival group. At a cut-off point of 75.65 μg/L, PCT showed 80.0% sensitivity and 90.0% specificity for the judgment of death, with optimal area under the curve of 0.886 (P<0.05). C-reactive protein (CRP), white blood cell (WBC) and neutrophil lymphocyte ratio (NLR) had no significant difference in the severity and the degree of organ dysfunction of neonates with septicemia(all P>0.05). Conclusion: Compared to CRP, WBC and NLR, PCT has high value in predicting the severity, the degree of organ dysfunction and the prognosis of neonates with septicemia.

Changes and clinical significances of mitochondrial coupling factor 6 and cytochrome C in neonatal sepsis

Objective To evaluate the levels of plasma coupling factor 6(CF6) and cytochrome C(Cyt-c) in neonatal sepsis, and to explore the clinical significance in neonatal sepsis. Methods A total of 88 neonates admitted to Hunan Children′s Hospital from January 2015 to April 2015 were collected.Neonates were divided into non-sepsis group(n=42) and sepsis group(n=46). According to the severity of infection, the non-sepsis group was further divided into non-infection group(n=20) and common infection group(n=22); the sepsis group was further divided into general sepsis group (31 cases, no organ failure) and severe sepsis group (15 cases, combined with multiple organ failure). Femoral venous blood was collected in all patients before the use of antibiotics after admission.The levels of Cyt-c and CF6 in plasma were measured by ELISA, and the levels of C-reactive protein(CRP), procalcitonin (PCT) were measured.The changes of CF6 and Cyt-c between these groups were compared, and the sensitivity and specificity with the traditional sepsis index (CRP, PCT) were analyzed.The correlation between the levels of CF6, Cyt-c and neonatal critical illness score was analyzed. Results (1)In sepsis group, the levels of CF6 and Cyt-c[(109.7±8.9)pg/ml and (44.5±4.9)ng/ml] were significantly higher than those in the non-sepsis group[(46.3±6.0)pg/ml, (31.8±6.7)ng/ml, P<0.01, respectively]. (2) In the non-infection group, common infection group, general sepsis group and severe sepsis group, the levels of CF6 were (32.1±8.9)pg/ml, (59.3±7.2)pg/ml, (79.3±5.9)pg/ml, and (172.6±6.1)pg/ml, respectively; the levels of Cyt-c were (29.3±8.6)ng/ml, (35.4±4.1) ng/ml, (43.1±5.9) ng/ml, and (44.5±5.9)ng/ml, respectively.The differences between these groups were significant(P<0.01). (3)The receiver operating characteristic curve showed that the sensitivity and specificity of CF6 were 0.761, 0.732, and the Cyt-c were 0.739, 0.714.(4)Cyt-C and CF6 were negatively correlated with the neonatal critical illness score(r=-0.599, P<0.001; r=-0.337, P<0.01). Conclusion The levels of CF6 and Cyt-c increase in neonatal sepsis.The damage of mitochondria may be one of the pathological mechanisms in neonatal sepsis.The levels of CF6 and Cyt-c were closely related to the severity of neonatal sepsis. Key words: Sepsis; Mitochondria; Mitochondrial coupling factor 6; Cytochrome C,

Relationship between blood lactic acid, blood procalcitonin, C-reactive protein and neonatal sepsis and corresponding prognostic significance in sick children

The study was conducted to evaluate the relationship between the blood lactic acid (BLA) level, serum procalcitonin (PCT), C-reactive protein (CRP) and the severity and prognosis of neonatal sepsis. A retrospective analysis was conducted on 90 children with sepsis admitted into the Intensive Care Unit (ICU) of the Hubei Institute for Nationalities Af liated Hospital hospital. Patients were divided into the non-survival group and the survival group. Severity of the 90 patients was evaluated according to Neonatal Critical Illness Score (NCIS). Observations were made on changes of the levels of BLA, PCT and CRP, correlation between BLA, PCT, CRP and NCIS as well as the association of the levels of these proteins with the prognosis of the patients. The 90 sick children were divided into the survival group (61 cases, 67.7%) and the non-survival group (29 cases, 32.2%). They were further stratified into the extremely severe group (n=20), severe group (n=39) and non-severe group (n=31) according to NCIS scoring standard. The BLA and NCIS scores of the non-survival group were significantly greater than those of the survival group. The difference was statistically significant (P<0.05). We found that there was a significant negative correlation between the BLA values and NCIS scores of the two groups. We also demonstrated significant positive correlation between the BLA value, PCT and CR (P<0.05). We observed a significant negative correlation between PCT, CRP and NCIS scores (P<0.05). The PCT level of the non-survival group was significantly higher than that of the survival group (P<0.05), while the NCIS score was significantly lower than that of the survival group (P<0.05). The CRP and PCT protein expression results of the sepsis patients were higher than those of the control group. Therefore, there is a significant correlation between BLA, CRP, PCT and NCIS. The lower the NCIS score is, the more significant the increase of BLA, PCT and CRP. Thus, the combined detection of levels of BLA, PCT and CRP may predict the severity of neonatal sepsis patients and their prognosis.

Relationship Between Serum Albumin Levels and Infections in Newborn Late Preterm Infants.

BackgroundWe aimed to evaluate the clinical value of serum albumin levels for the evaluation and prognosis of late preterm infants with infections.Material/MethodsThis was a retrospective study performed in late preterm infants admitted at the neonatal intensive care unit (NICU) of the Liaocheng People’s Hospital between July 2012 and March 2013. Data, including laboratory test results, neonatal critical illness score (NCIS), perinatal complications and prognosis, were analyzed. The newborn infants were divided into 3 groups according to their serum albumin levels, (≥30 g/L, 25–30 g/L and ≤25 g/L for high, moderate, and low, respectively).ResultsAmong 257 patients, birth weight was 2003±348 g, gestational age was 35.7±2.3 weeks, and 59.1% were male. In addition, 127 (49.4%) were in the low albumin group. There were 32 patients with sepsis, 190 with infections, and 35 without infection, and their rates of hypoalbuminemia were 86.0%, 50.5%, and 30.7%, respectively (P<0.05). Albumin levels of the patients who survived were higher than those of the patients who died. In the low albumin group, the number of individual-event-critical NCIS cases and the frequency of multiple organs injuries were 63.8% and 28.3%, respectively, and were higher than in the 2 other groups. Mortality was higher in patients with sepsis. Hypoalbuminemia was associated with severe adverse outcomes (odds ratio=6.3, 95% confidence interval: 3.7–10.9, P<0.001).ConclusionsHypoalbuminemia was frequent among neonates with sepsis. Lower albumin levels might be associated with a poorer prognosis. Albumin levels could be appropriate for the diagnosis and prognosis of late preterm neonates with infections.

The prognostic value of arterial blood lactate for severe neonatal asphyxia

Objective To investigate the prognostic value of arterial blood lactate(Lac) and lactate clearance rate(LCR) for severe neonatal asphyxia. Methods One hundred and fifteen cases of severe neonatal asphyxia admitted in NICU of our hospital from January 2011 to October 2014 were retrospectively analyzed.Lac and LCR values were measured at multiple time points and were compared between those died(27 cases, the death group) and those survived(88 cases, the survival group). The correlation between prognosis and Lac as well asLCR was investigated.Receiver operating characteristic(ROC) curves were drawn to evaluate the prognostic value of Lac and LCR at different time points. Results No significant differences in initial lactate levels and neonatal critical illness score(NCIS) were detected between the two groups(P>0.05), while Lac and LCR values at 1 h, 2 h, and 6 h showed significant differences between the two groups(P<0.05). The low-LCR group showed a higher rate of multiple organ dysfunction syndrome and mortality rates than the high-LCR group(44.64% vs.15.25%, P=0.001; 32.14% vs.15.25%, P=0.033, respectively). Post-treatment Lac level was positively correlated with prognosis, while LCR at 1 h, 2 h, and 6 h were negatively correlated with prognosis.Areas under curve of Lac ROC at 1 h, 2 h, and 6 h were 0.625, 0.719, and 0.835 respectively, while areas under curve of LCR ROC at 1 h, 2 h, and 6 h were 0.676, 0.784, and 0.898 respectively. Conclusion Low LCR for severe neonatal asphyxia predicts poor prognosis.Lac level and LCR at 6 h after emergency treatment is a prognostic indicator for severe neonatal asphyxia. Key words: Infant, newborn; Lactate; Lactate clearance rate; Severe asphyxia; Prognosis

Evaluation of the clinicalapplication of simplified neonatal critical illness score

：Objective To discuss theclinical application of simplified neonatal critical illness score (sNCTS)in comparisonwith original neonatal critical illness score(oNCIS)published in 2001.Method A total of705 neonates referred to neonate ICU(NICU)from 1 st January 2007 to 31th December 2009were prospectively studied with control.The patients were scored by oNCIS on admissionday,3rd,7th days after admission and on the day of discharge or dead.At the first scoringon admission,2 items of the PaO2 and pH were excluded from oNCIS's 10 items,and theremaining 8 items were used.Three items of plasma sodium,potassium and creatinine or BUNwere scored out from 8 items and the still remained 5 items were used for the subsequent 3scorings.The remaining 8 and 5 items were used as a simplified neonatal critical illnessscore.The simplified NCIS was evaluated by comparing the patients'condition that wasassessed by the originat NCIS.The consistency rate between oNCIS and sNCIS should be over80%.Results There were 8 items were used to evaluate the severity of disease on admission,and the consistence rate was 86.7%with the original NCIS.The 5 items selected from theoriginal NCIS were used on the 3rd,the 7th days and the day of discharge or death.theconsistence rate with original NCIS were 86.6%to 95.7%.A close correlation existed betweenthe original NCIS and simplified NCIS(P 0.05).Conclusions Comparedwith the original NCIS.the simplified NCIS is consistent to a large extent in diseaseassessment,which is a concise way to evaluate the critical ill neonates objectively andcan be easily applied to clinical practice.

ACTH, cortisol and aldosterone level of preterm infants with critical illness

Objective To investigate the effect of illness severity on preterm infant's hypothalamusputituary-adrenal (HPA) axis, we measured the serum concentration of cortisol,aldosterone and adrenocorticotropic hormone (ACTH). Methods Ninety preterm infants who were transferred to our hospital within 72 hours after birth were involved. These preterm infants were divided into two groups:gestational age (GA) ≥34 weeks' preterm infants and GA <34 weeks' preterm infants. We evaluated these preterm infants at the time of admission,day 7 and day 14 after birth with neonatal critical illness score (NCIS). Then they were divided into mild group and severe group by the lowest score. We measured their serum cortisol,aldosterone and ACTH at the time of admission,day 7 and day l4 after birth. Results (1) The serum cortisol concentration of preterm infants with severe illness was higher than that of preterm infants with mild illness. Among the GA ≥34 weeks' preterm infants,the serum cortisol concentration of preterm infants with severe illness was significandy higher than that of preterm infants with mild illness within 72 hours after birth (t = -2.263,P =0. 029). Among the GA <34 weeks' preterm infants,the serum cortisol concentration of preterm infants with severe illness was significantly higher than that of preterm infants with mild illness on day 14 after birth (t =-2. 913 ,P =0. 006). (2) Among the preterm infants with severe illness,the serum cortisol concentration of the GA≥34 weeks' was significantly higher than that of the GA < 34 weeks' within 72 hours after birth (t =-2. 641 ,P =0. 010) ;the serum cortisol concentration of the GA <34 weeks' was significantly higher than that of the GA≥34 weeks' on the day 14 after birth(t = -2. 189,P =0. 036) . (3) The serum cortisol concentration was significantly decreased in the GA≥34 weeks'preterm infants (F = 4. 679, P =0. 012). (4) The serum cortisol concentration of aldosterone and ACTH was not significantly different between preterm infants with severe illness and those with mild illness. Conclusion The preterm infant already has the ability to respond to stimuli by regulating cortisol secretion. The serum cortisol concentration increases as disease severity worsens.Serum aldosterone and ACTH concentration are not correlated with the severity of the disease. Key words: Adrenal cortex functiou; Cortisol; Aldosterone; Adrenocorticotropic hormoue; Preterm infant