A Neonatal Sequential Organ Failure Assessment Score Predicts Mortality to Late-Onset Sepsis in Preterm Very Low Birth Weight Infants

Abstract

Background An 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. Methods Retrospective, single-center study of bacteremic preterm VLBW newborns admitted between 2012 and 2016. nSOFA scores were derived for patients with LOS at multiple time points surrounding the sepsis evaluation. Results nSOFA 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 \u2009<\u20090.001), +6\u2009h (15% vs 64%, p \u2009=\u20090.002), and +12\u2009h (7% vs 71%, p \u2009<\u20090.001) 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 \u2009=\u20090.001), 0.78 at +6\u2009h (0.66–0.92; p \u2009<\u20090.001), and 0.93 at +12\u2009h (0.86–0.997; p \u2009<\u20090.001). Conclusions The 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 toward improvements in neonatal sepsis outcomes.