Ognean Maria Livia, Coțovanu Bianca, Teacoe Dumitru Alin, Radu Ioana Andrada, Todor Samuel Bogdan, Ichim Cristian, Mureșan Iris Codruța, Boicean Adrian-Gheorghe, Galiș Radu, Cucerea Manuela
Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania.
Department of Neonatology, Clinical County Emergency Hospital Sibiu, 550245 Sibiu, Romania.
Healthcare (Basel). 2023 Dec 9;11(24):3131. doi: 10.3390/healthcare11243131.
Transportation of sick newborns is a major predictor of outcome. Prompt identification of the sickest newborns allows adequate intervention and outcome optimization. An optimal scoring system has not yet been identified.
To identify a rapid, accurate, and easy-to-perform score predictive for neonatal mortality in outborn neonates.
All neonates admitted by transfer in a level III regional neonatal unit between 1 January 2015 and 31 December 2021 were included. Infants with congenital critical abnormalities were excluded (N = 15). Gestational age (GA), birth weight (BW), Apgar score, place of birth, time between delivery and admission (AT), early onset sepsis, and sick neonatal score (SNS) were collected from medical records and tested for their association with mortality, including in subgroups (preterm vs. term infants); GA, BW, and AT were used to develop MSNS-AT score, to improve mortality prediction. The main outcome was all-cause mortality prediction. Univariable and multivariable analysis, including Cox regression, were performed, and odds ratio and hazard ratios were calculated were appropriate.
418 infants were included; 217/403 infants were born prematurely (53.8%), and 20 died (4.96%). Compared with the survivors, the non-survivors had lower GA, BW, and SNS scores ( < 0.05); only the SNS scores remained lower in the subgroup analysis. Time to admission was associated with an increased mortality rate in the whole group and preterm infants ( < 0.05). In multiple Cox regression models, a cut-off value of MSNS-AT score ≤ 10 was more precise in predicting mortality as compared with SNS (AUC 0.735 vs. 0.775) in the entire group and in the preterm infants group (AUC 0.885 vs. 0.810).
The new MSNS-AT score significantly improved mortality prediction at admission in the whole study group and in preterm infants as compared with the SNS score, suggesting that, besides GA and BW, AT may be decisive for the outcome of outborn preterm infants.
患病新生儿的转运是预后的主要预测指标。及时识别病情最严重的新生儿可进行充分干预并优化预后。尚未确定最佳评分系统。
确定一种快速、准确且易于实施的评分，用于预测外转新生儿的死亡率。
纳入2015年1月1日至2021年12月31日期间在三级区域新生儿病房通过转运入院的所有新生儿。排除患有先天性严重异常的婴儿（N = 15）。从病历中收集胎龄（GA）、出生体重（BW）、阿氏评分、出生地点、分娩至入院时间（AT）、早发型败血症和患病新生儿评分（SNS），并测试它们与死亡率的相关性，包括在亚组（早产儿与足月儿）中的相关性；使用GA、BW和AT来制定MSNS - AT评分，以改善死亡率预测。主要结局是全因死亡率预测。进行单变量和多变量分析，包括Cox回归，并在适当情况下计算比值比和风险比。
纳入418例婴儿；403例婴儿中有217例（53.8%）为早产儿，20例死亡（4.96%）。与幸存者相比，非幸存者的GA、BW和SNS评分较低（<0.05）；在亚组分析中只有SNS评分仍然较低。入院时间与全组和早产儿的死亡率增加相关（<0.05）。在多个Cox回归模型中，与SNS相比，MSNS - AT评分≤10的临界值在预测全组和早产儿组的死亡率方面更精确（AUC分别为0.735对0.775以及0.885对0.810）。
与SNS评分相比，新的MSNS - AT评分在整个研究组和早产儿中显著改善了入院时的死亡率预测，表明除了GA和BW外，AT可能对外转早产儿的预后起决定性作用。
