Department of Pediatrics, Columbia University School of Medicine, New York, New York.
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
JAMA Netw Open. 2021 Feb 1;4(2):e2036518. doi: 10.1001/jamanetworkopen.2020.36518.
Infection in neonates remains a substantial problem. Advances for this population are hindered by the absence of a consensus definition for sepsis. In adults, the Sequential Organ Failure Assessment (SOFA) operationalizes mortality risk with infection and defines sepsis. The generalizability of the neonatal SOFA (nSOFA) for neonatal late-onset infection-related mortality remains unknown.
To determine the generalizability of the nSOFA for neonatal late-onset infection-related mortality across multiple sites.
DESIGN, SETTING, AND PARTICIPANTS: A multicenter retrospective cohort study was conducted at 7 academic neonatal intensive care units between January 1, 2010, and December 31, 2019. Participants included 653 preterm (<33 weeks) very low-birth-weight infants.
Late-onset (>72 hours of life) infection including bacteremia, fungemia, or surgical peritonitis.
The primary outcome was late-onset infection episode mortality. The nSOFA scores from survivors and nonsurvivors with confirmed late-onset infection were compared at 9 time points (T) preceding and following event onset.
In the 653 infants who met inclusion criteria, median gestational age was 25.5 weeks (interquartile range, 24-27 weeks) and median birth weight was 780 g (interquartile range, 638-960 g). A total of 366 infants (56%) were male. Late-onset infection episode mortality occurred in 97 infants (15%). Area under the receiver operating characteristic curves for mortality in the total cohort ranged across study centers from 0.71 to 0.95 (T0 hours), 0.77 to 0.96 (T6 hours), and 0.78 to 0.96 (T12 hours), with utility noted at all centers and in aggregate. Using the maximum nSOFA score at T0 or T6, the area under the receiver operating characteristic curve for mortality was 0.88 (95% CI, 0.84-0.91). Analyses stratified by sex or Gram-stain identification of pathogen class or restricted to infants born at less than 25 weeks' completed gestation did not reduce the association of the nSOFA score with infection-related mortality.
The nSOFA score was associated with late-onset infection mortality in preterm infants at the time of evaluation both in aggregate and in each center. These findings suggest that the nSOFA may serve as the foundation for a consensus definition of sepsis in this population.
新生儿感染仍然是一个重大问题。由于缺乏败血症的共识定义，该人群的进展受到阻碍。在成年人中，序贯器官衰竭评估（SOFA）通过感染使死亡率具有可操作性，并定义了败血症。新生儿 SOFA（nSOFA）对新生儿晚发性感染相关死亡率的通用性仍不清楚。
确定 nSOFA 在多个地点对新生儿晚发性感染相关死亡率的通用性。
设计、地点和参与者：这是一项多中心回顾性队列研究，在 2010 年 1 月 1 日至 2019 年 12 月 31 日期间在 7 家学术新生儿重症监护病房进行。参与者包括 653 名早产儿（<33 周）极低出生体重儿。
晚发性（>72 小时生命）感染，包括菌血症、真菌血症或外科腹膜炎。
主要结局是晚发性感染发作的死亡率。在确认有晚发性感染的幸存者和非幸存者中，比较了发病前和发病后 9 个时间点（T）的 nSOFA 评分。
在符合纳入标准的 653 名婴儿中，中位胎龄为 25.5 周（四分位距，24-27 周），中位出生体重为 780 g（四分位距，638-960 g）。共有 366 名婴儿（56%）为男性。97 名婴儿（15%）发生晚发性感染发作死亡。总队列中各研究中心的死亡率受试者工作特征曲线下面积范围为 0.71 至 0.95（T0 小时）、0.77 至 0.96（T6 小时）和 0.78 至 0.96（T12 小时），所有中心和总中心均有实用性。使用 T0 或 T6 时的最大 nSOFA 评分，死亡率的受试者工作特征曲线下面积为 0.88（95%CI，0.84-0.91）。按性别或革兰氏染色确定病原体类别进行分层分析，或仅限于出生于<25 周完成妊娠的婴儿，并未降低 nSOFA 评分与感染相关死亡率之间的关联。
nSOFA 评分与评估时早产儿晚发性感染死亡率相关，在总人群和每个中心均相关。这些发现表明，nSOFA 可能成为该人群败血症共识定义的基础。
