Cited by 38Infant Nutrition and HealthInfant Development and Preterm CareNeonatal and Maternal Infections

Evaluation of the neonatal sequential organ failure assessment and mortality risk in preterm infants with necrotizing enterocolitis

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Lewis, Angela N., de la Cruz, Diomel, Wynn, James L., Frazer, Lauren C., Yakah, William, Martin, Camilia R., Yang, Heeju, Itriago, Elena +6 more·2022·Neonatology

Abstract

INTRODUCTION: The neonatal sequential organ failure assessment (nSOFA) score is a tool for calculating mortality risk of infants in the neonatal intensive care unit. The utility of the nSOFA in determining the risk of mortality or the association with surgical intervention among infants with necrotizing enterocolitis (NEC) has not been investigated. METHODS: We performed a retrospective, cohort study of preterm (<37 weeks) infants with NEC Bell's stage ≥ IIA at six hospitals from 2008 to 2020. An nSOFA score (range 0-15) was assigned to each patient at nine time points from 48 h before or after clinical illness was suspected. RESULTS: Of the 259 infants, nSOFA scores for infants who died (n = 39) or had the composite outcome of surgery or death (n = 114) were significantly higher (p < 0.05) early in the NEC course compared to nSOFA scores for infants who survived medical NEC. Twelve hours after evaluation, the area under the receiver operating characteristic curve was 0.87 (95% confidence interval [CI], 0.80-0.93) to discriminate for mortality and 0.84 (95% CI, 0.79-0.90) for surgery or death (p < 0.001). A maximum nSOFA score of ≥4 at -6, 0, 6, or 12 h following evaluation was associated with a 20-fold increase in mortality and 19-fold increase in surgery or death compared with a score of <4 (p < 0.001). CONCLUSION: In this multicenter cohort, the nSOFA score was able to discriminate well for death as well as surgery or death among infants with NEC. The nSOFA is a clinical research tool that may be used in infants with NEC to improve classification by objective quantification of organ dysfunction.

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Authors
Lewis, A. N., de la Cruz, D., Wynn, J. L., Frazer, L. C., Yakah, W., Martin, C. R., Yang, H., Itriago, E., Unger, J., Hair, A. B., Miele, J., Sullivan, B. A., Husain, A., & Good, M.
Affiliations
  • St. Louis Children's Hospital (US)
  • UF Health Shands Hospital (US)
  • Boston Children's Hospital (US)
  • Beth Israel Deaconess Medical Center (US)
  • Baylor College of Medicine (US)
  • University of Virginia Children's Hospital (US)
Venue
Neonatology
Publisher
S. Karger AG
Published
2022
Volume
119
Issue
3
Pages
334-344
ISSN
  • 1661-7800 (ISSN-L)
  • 1661-7819
OpenAlex
W4221014051
Cited by
36
References
20
Citations by year
2026: 12 · 2025: 8 · 2024: 6 · 2023: 6 · 2022: 4
FWCI
3.70
Type
journal article
Language
en
Open access
Locations
  • Neonatology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of General Medical Sciences (R01GM128452)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124614, R01DK118568)
  • National Institute of Biomedical Imaging and Bioengineering (R43EB029863)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD105301, R01HD089939, R01HD106359, T32HD098061, R01HD097081)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
Keywords
necrotizing enterocolitis, preterm infants, mortality prediction, organ dysfunction, prognostic scoring, bell stage
MeSH terms
Humans, Infant, Infant, Newborn, Infant, Newborn, Diseases, Infant, Premature, Retrospective Studies, Cohort Studies, Enterocolitis, Necrotizing, Organ Dysfunction Scores

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