Hourly kinetics of critical organ dysfunction in extremely preterm infants
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Abstract Rationale Use of severity of illness scores to classify patients for clinical care and research is common outside of the neonatal ICU. Extremely premature (<29 weeks’ gestation) infants with extremely low birth weight (<1,000 g) experience significant mortality and develop severe pathology during the protracted birth hospitalization. Objectives To measure at high resolution the changes in organ dysfunction that occur from birth to death or discharge home by gestational age and time, and among extremely preterm infants with and without clinically meaningful outcomes using the neonatal sequential organ failure assessment score. Methods A single-center, retrospective, observational cohort study of inborn, extremely preterm infants with extremely low birth weight admitted between January 2012 and January 2020. Neonatal sequential organ failure assessment scores were calculated every hour for every patient from admission until death or discharge. Measurements and Main Results Longitudinal, granular scores from 436 infants demonstrated early and sustained discrimination of those who died versus those who survived to discharge. The discrimination for mortality by the maximum score was excellent (area under curve, 0.91; 95% confidence intervals, 0.88–0.94). Among survivors with and without adverse outcomes, most score variation occurred at the patient level. The weekly average score over the first 28 days was associated with the sum of adverse outcomes at discharge. Conclusions The neonatal sequential organ failure assessment score discriminates between survival and nonsurvival on the first day of life. The major contributor to score variation occurred at the patient level. There was a direct association between scores and major adverse outcomes, including death.
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The nSOFA has strong utility to predict all-cause mortality, including in extremely low birth weight infants.
“Validated in multicenter studies, the nSOFA has strong utility to predict all-cause mortality (11) including ELBWs (12)”
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 [12]
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Self-citationLagnese, K., Sheth, S., Vice, S., Rajderkar, D., Roig, J. C., Weiss, M., & Wynn, J. L. (2026) · Frontiers in Pediatrics · doi:10.3389/fped.2026.1844058
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- Authors
- Lavilla, O. C., Aziz, K. B., Lure, A. C., Gipson, D., de la Cruz, D., & Wynn, J. L.
- Affiliations
- Department of Pediatrics and
- Johns Hopkins University (US)
- University of Florida (US)
- Corresponding author
- Wynn, James L.
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-01-01
- Volume
- 205
- Issue
- 1
- Pages
- 75-87
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- PMC
- PMC8865589
- OpenAlex
- W3201248593
- Cited by
- 22
- References
- 50
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 6 · 2023: 4 · 2022: 3 · 2021: 1
- FWCI
- 3.46
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- NIH (GM128452, HD089939, HD097081, EB029863)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Keywords
- extremely preterm infants, extremely low birth weight, organ dysfunction, Sequential Organ Failure Assessment score, mortality prediction, adverse outcomes, neonatal intensive care, gestational age
- MeSH terms
- Female, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Diseases, Longitudinal Studies, Male, Multiple Organ Failure, Prognosis, Retrospective Studies, ROC Curve, Time Factors, Survival Analysis, Area Under Curve, Infant, Extremely Low Birth Weight, Infant, Extremely Premature, Organ Dysfunction Scores
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