Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct-Dec;22(4):211-216.
doi: 10.4103/0971-9261.214455.

"Neo-PIRO": Introducing a Novel Grading System for Surgical Infections of Neonates

G Raghavendra Prasad  1 , J V Subba Rao  2 , Amtul Aziz  1 , T M Rashmi  2
Affiliations

"Neo-PIRO": Introducing a Novel Grading System for Surgical Infections of Neonates

G Raghavendra Prasad et al. J Indian Assoc Pediatr Surg. 2017 Oct-Dec.

Abstract

Introduction: Quantification of surgical sepsis was never done beyond superficial, subfascial, and deep surgical site infection (SSI). Invasive surgical sepsis with systemic manifestation has not been tried to be quantified in general and pediatric surgery in particular. Hence, this attempts to develop a novel grading system to quantify neonatal surgical infections.

Materials and methods: Predisposing factors, infection, response, and organ failure (PIRO) is being used in critical care institutions for medical sepsis; it was modified with neonate-specific surgical parameters. Authors have developed a grading of these parameters into Grade I, II, and III.

Results: A blinded statistical test was performed and results were put to test. Extended Mantel-Haenszel Chi-square test validated linear relationship with grade and outcome, hospital stay, deep SSI, and organ dysfunction. Analysis of variance also showed the significant relationship of changing trends in grade and outcome. (1) Higher the grade indicated the probability of death. (2) Grade I patients had less duration of hospital stay compared to Grade II and III (P = 0.04). (3) The requirement of organ support and SSI were also more in Grade III. (4) Grade I patients had less increase in trends compared to Grade II and III (F = 4.86). Authors therefore feel Neo-PIRO seems to be the first scoring system that shows a linear relationship between scores and grade.

Conclusion: Neo-PIRO is a novel grading system with surgical neonate-specific parameters. Future versions to include molecular parameters, as well as parameters selected by regression analysis.

Keywords: Neonatal surgical infections; and organ failure”; infection; neonate-specific surgical infection scoring system; response; “neo-predisposing factors.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Similar articles

See all similar articles

References

    1. Waters M, Nightingale P, Edwards JD. A critical study of the APACHE II scoring system using earlier data collection. Arch Emerg Med. 1990;7:16–20. - PMC - PubMed
    1. Haq A, Patil S, Parcells AL, Chamberlain RS. The simplified acute physiology score III is superior to the simplified acute physiology score II and acute physiology and chronic health evaluation II in predicting surgical and ICU mortality in the “oldest old”. Curr Gerontol Geriatr Res. 2014;2014:934852. - PMC - PubMed
    1. Gray JE, Richardson DK, McCormick MC, Workman-Daniels K, Goldmann DA. Neonatal therapeutic intervention scoring system: A therapy-based severity-of-illness index. Pediatrics. 1992;90:561–7. - PubMed
    1. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: A reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638–52. - PubMed
    1. Jones AE, Trzeciak S, Kline JA. The sequential organ failure assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med. 2009;37:1649–54. - PMC - PubMed