Assessing neonatal sequential organ failure (nSOFA) scores in suspected late-onset neonatal sepsis among preterm infants: implications for morbidity and mortality
Open accessAbstract
BACKGROUND: The neonatal Sequential Organ Failure Assessment (nSOFA) score is an organ dysfunction score developed for predicting mortality risk in preterm neonates with proven late-onset neonatal sepsis (LONS) and necrotising enterocolitis. However, the utility of the nSOFA score in determining the risk of retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) or mortality in patients with suspected LONS is unknown. METHODS: We performed a dual-centre retrospective cohort study of preterm (gestational age <32 weeks) neonates suspected of LONS, from 2016 to 2020 at two neonatal intensive care units. The nSOFA scores (range 0-15) were calculated for each suspected LONS episode at various time points around the sepsis evaluation. A nSOFA burden score was calculated, by counting each time point the nSOFA score was ≥4 during all sepsis episodes (in the time period -6 to 48 hours). The association with 10-day sepsis-related mortality and severe ROP and BPD was assessed. RESULTS: A total of 1157 episodes of suspected LONS in 706 neonates occurred. The nSOFA was significantly associated with 10-day mortality at various time points. The nSOFA score 6 hours after drawing a blood culture (T6) was associated with 10-day sepsis-related mortality (adjusted OR (aOR) 1.31; 95% CI (1.22 to 1.40; p<0.001)), in a model corrected for gestational age, sex, age at evaluation and gestational age-adjusted birth weight. The nSOFA burden scores were positively associated with the risk for ROP (aOR 1.24; 95% CI 1.09 to 1.41; p=0.001) and BPD (aOR 1.30; 95% CI 1.13 to 1.50; p<0.001). CONCLUSION: Our findings show that the nSOFA score in preterm neonates suspected of LONS is associated with subsequent mortality, ROP and BPD. Incorporating nSOFA scores may help to identify sepsis survivors at the highest risk of adverse outcomes, who may require more intensive monitoring and adapted therapy.
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The cumulative nSOFA score during late onset sepsis events in preterm infants is positively associated with neurodevelopmental outcomes at two years of age.
“Kurul et al. showed the cumulative nSOFA score during late onset sepsis events in preterm infants was positively associated with neurodevelopmental outcomes at two years of age (16).”
From Association of the neonatal sequential organ failure assessment score with neurological outcomes in infants diagnosed with hypoxic-ischemic encephalopathy (2026) · cites this paper as [16]
The Outcome measurements section lists 10-day mortality, retinopathy of prematurity and bronchopulmonary dysplasia, and the Results report associations with those outcomes. A search for neurodevelopmental outcomes at two years found no passage assessing them, so this copy does not verify the attributed association. (LLM, conf=0.78)
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- Authors
- Kurul, Ş., Reijnierse, J. J., Koppens, H. J., Onland, W., Simons, S. H. P., Reiss, I. K. M., Taal, H. R., & Visser, D. H.
- Affiliations
- Erasmus MC (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Taal, H Rob
- Venue
- BMJ Paediatrics Open
- Publisher
- BMJ
- Published
- 2024-12
- Volume
- 8
- Issue
- 1
- Pages
- e002884
- ISSN
- 2399-9772 (ISSN-L)
- PMC
- PMC11683960
- OpenAlex
- W4405875007
- Cited by
- 10
- References
- 23
- Citations by year
- 2026: 9 · 2025: 1
- FWCI
- 4.12
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- BMJ Paediatrics Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- late-onset neonatal sepsis, preterm infants, sepsis mortality, retinopathy of prematurity, bronchopulmonary dysplasia, organ dysfunction, sepsis risk stratification, adverse neonatal outcomes, necrotizing enterocolitis
- MeSH terms
- Neonatal Sepsis, Bronchopulmonary Dysplasia, Female, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Intensive Care Units, Neonatal, Male, Retinopathy of Prematurity, Retrospective Studies, Enterocolitis, Necrotizing, Organ Dysfunction Scores
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