Neonatal Sequential Organ Failure Assessment (nSOFA) Score within 72 Hours after Birth Reliably Predicts Mortality and Serious Morbidity in Very Preterm Infants

Abstract

The aim of this study was to assess the applicability of the neonatal sequential organ failure assessment score (nSOFA) within 72 h after delivery as a predictor for mortality and adverse outcome in very preterm neonates. Inborn neonates <32 weeks of gestation were evaluated. The nSOFA scores were calculated from medical records in the first 72 h after birth and the peak value was used for analysis. Death or composite morbidity at hospital discharge defined the adverse outcome. Composite morbidity consisted of chronic lung disease, intraventricular haemorrhage ≥grade III, periventricular leukomalacia and necrotizing enterocolitis. Among 423 enrolled infants (median birth weight 1070 g, median gestational age 29 weeks), 27 died and 91 developed composite morbidity. Death or composite morbidity was associated with organ dysfunction as assessed by nSOFA, systemic inflammatory response, and low birthweight. The score >2 was associated with OR 2.5 (CI 1.39−4.64, p = 0.002) for the adverse outcome. Area under the curve of ROC was 0.795 (95% CI = 0.763−0.827). The use of nSOFA seems to be reasonable for predicting mortality and morbidity in very preterm infants. It constitutes a suitable basis to measure the severity of organ dysfunction regardless of the cause.

Keywords: neonatal intensive care; organ dysfunction score; preterm birth.

Figure 1

Flow chart. DR = delivery room.

Figure 2

Comparison of nSOFA peak values in the first 72 h after birth between the group with no major morbidity (median 0, IQR 0–1) and with adverse outcome (median 2, IQR 0–9). Mann-Whitney U test, p-value < 0.001. Circles represent outliers, stars represent far out values according to Tukey’s fences. nSOFA = Neonatal Sequential Organ Failure Assessment. Adverse outcome = Death or major morbidity.

Figure 3

Comparison of nSOFA score peak values in the first 72 h after birth in subgroups without major morbidity (median 0, IQR 0–1), with major morbidity (median 2, IQR 0–6) and death (median 11, IQR 7–14). Independent samples Kruskal-Wallis test, p-value < 0.001. Circles represent outliers, stars represent far out values according to Tukey’s fences. nSOFA = Neonatal Sequential Organ Failure Assessment. CLD = Chronic Lung Disease. PIVH = Peri/Intraventricular Haemorrhage. PVL = Periventricular Leukomalacia. NEC = Necrotizing Enterocolitis.