Evaluation of the “Neonatal Sequential Organ Failure Assessment” to Predict Mortality in Late-Onset Sepsis in Very Preterm Infants

Abstract

Abstract Introduction We aimed to evaluate the use of “Neonatal Sequential Organ Failure Assessment” (nSOFA) scoring in predicting mortality, to compare the accuracy of nSOFA scores at different time points in very preterm infants with late-onset sepsis (LOS), and to investigate other possible parameters that would improve the prediction. Methods This single-center, retrospective study included preterm infants born atS<32 weeks’ gestation with culture-proven LOS. The nSOFA scores of non-fatal and fatal episodes were compared at nine time points. Results Of 120 culture-proven LOS episodes in 106 infants, 90 (75%) episodes were non-fatal and 30 (25%) episodes were fatal. The mean birth weight (BW) of the infants who died was lower than that of survivors (p=0.038). In the fatal LOS episodes, median nSOFA scores were higher at all time points measured before sepsis evaluation, at the time of evaluation, and at all time points measured after the evaluation (p<0.001). nSOFA scores before death and at 48 hours were higher in the fatal episodes (p<0.001). At the time of sepsis assessment, nSOFA score>4 was associated with a 7- to 16-fold increased risk of mortality. Adjustment for BW, lymphocyte and monocyte counts increased the risk to 9- to 18-fold. Conclusion This study demonstrated that the use of nSOFA to predict mortality and morbidity in extremely preterm infants seems feasible. The scoring system could be improved by evaluating the other parameters.