Utility of the Modified Sick Neonatal Score to Predict the Mortality in Outborn Neonates: A Cohort Study

Abstract

Introduction: Illness severity scoring systems are essential tools for reducing mortality by identifying disease severity and providing early intervention. The application of the Modified Sick Neonatal Score (MSNS) in resource-limited settings has been studied in inborn neonates, but there is a lack of data regarding outborn neonates. Aim: To predict mortality in outborn transported neonates by applying the MSNS score. Materials and Methods: This cohort study was conducted from June 2020 to November 2021 in the Department of Paediatrics at Government Medical College, Nagpur, Maharashtra, India. Parameters of the MSNS scoring system (respiratory effort, heart rate, axillary temperature, capillary refilling time, random blood sugar, oxygen saturation, gestational age, and birth weight) were evaluated in all admitted outborn neonates upon admission, and outcomes (discharge or death) were noted. The score and individual parameters were correlated with the outcome. Chi-square test, Fischer's-exact test, and Mann-Whitney U test were applied to statistically analyse the data. A receiver operating curve was plotted to determine the cut-off value for the score to predict mortality. Results: In the present study, 866 (58.2%) neonates were male, while 622 (41.8%) were female, and the mean age at admission was 43.3±58.9 hours. Nearly two-thirds of the neonates were born at term, and the mean birth weight was 2191.62±595.47 gm. A total of 91.7% of the neonates were referred by government facilities, and 82.8% of the neonates were transported by ambulance, but only one-third of the ambulance-transported neonates were accompanied by a health assistant. The mean traveling distance was 83.57±72.79 km, and the mean transport duration was 2.14±1.07 hours. The common clinical diagnosis were sepsis (42.68%), respiratory distress (19.89%), and birth asphyxia (14.78%). The neonatal mortality rate was 29.3%. The total MSNS score for neonates who survived was 11.26±2.34, compared to 8.52±2.23 for the neonates who died (p-value <0.0001). The sensitivity was 80.5%, with a specificity of 63.1% and an area under the curve of 0.79 (OR-24.72, 95% CI 0.77-0.81, p-value <0.001) when using the optimal cut-off score of ≤10. Conclusion: The MSNS score of ≤10 has better sensitivity and specificity in predicting neonatal mortality in outborn transported neonates.