The utility of neonatal sequential organ failure assessment in mortality risk in all neonates with suspected late-onset infection.

OBJECTIVE

Assess the utility of the neonatal sequential organ failure assessment score (nSOFA) for evaluation-specific mortality discrimination in all late-onset infection (LOI) evaluations.

METHODS

Retrospective Cohort of all neonates who had an LOI evaluation from 2012 to 2023 in a single level IV Academic NICU in Florida, USA. The primary outcome was LOI-evaluation-specific mortality.

RESULTS

1481 neonates had 2916 LOI evaluations with a 3.8% mortality rate. The AUROC for the nSOFA score at evaluation was 0.76 (95% CI 0.71-0.81) and improved to 0.82 (95% CI 0.78-0.87) six hours after. nSOFA ≥2 within 6 h of the start of the LOI was 87% sensitive and 66% specific, with a 99% NPV for mortality, p < 0.0001.

CONCLUSIONS

The nSOFA score had good to excellent mortality discrimination at the LOI evaluation level. These results solidify the utility of the nSOFA score as the foundation for a consensus definition of neonatal sepsis.