575 - Utility of the Neonatal Sequential Organ Failure Assessment (nSOFA) Score in Predicting Morbidity and Mortality in Infants with Early-onset Sepsis (EOS)

Poster Number: 575
Publication Number: 575.427

Megan M. Daniele, NewYork-Presbyterian Morgan Stanley Children's Hospital, Bronx, NY, United States; Rakesh Sahni, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Richard A. Polin, Columbia University Vagelos College of Physicians and Surgeons, New york, NY, United States

Background: Sepsis is a major cause of morbidity and mortality in neonates. In adults and older pediatric patients, the Sequential Organ Failure Assessment (SOFA) score enables quantification of life-threatening organ dysfunction. However, the SOFA score is not applicable to neonates because the clinical variables used in the SOFA score are not developmentally appropriate. In order to derive a similar operationalization method in neonates with sepsis, the neonatal SOFA (nSOFA) was developed and validated. The absolute and change in nSOFA is associated with mortality in neonatal late-onset sepsis. However, the nSOFA score has yet to be validated in neonates with EOS.

Objective: To assess the utility of the nSOFA score in predicting morbidity and mortality in neonates with EOS.

Design/Methods: Retrospective, single-center study of infants admitted to a Level IV NICU between 2013-2020. Neonates with early-onset ( < 72 hours of life) infection as defined by bacteremia, or fungemia were included. Physiologic data were collected every 6 hours for the first 36 hours of life to derive nSOFA scores using the nSOFA scoring system. nSOFA scores were compared in survivors and non-survivors and in infants with or without major morbidities. A single composite “morbidity score” was calculated which included the following outcomes: bronchopulmonary dysplasia, periventricular leukomalacia, intraventricular hemorrhage (grade II or higher), retinopathy of prematurity (stage III or higher), necrotizing enterocolitis (Bells stage II or higher) and spontaneous intestinal perforation.

Results: nSOFA scores were determined for 20 neonates with documented infection at 0, 6, 12, 18, 24, 30, and 36 hours of life (HOL). Compared to neonates who did not survive (n=2), neonates who survived (n=18) had significantly lower nSOFA scores (Figure 1). The peak nSOFA score was significantly higher in non-survivors vs. survivors (12.5 vs. 2.2, p < 0.001) (Figure 2). The peak nSOFA trended lower in neonates without major morbidity vs. those with major morbidity at discharge (0.6 vs. 3.3, p=0.09) (Figure 3).Conclusion(s): The nSOFA provides an objective score to help provide prognostic information in infants with early-onset sepsis. The nSOFA score may provide a basis for risk-stratifying neonates with EOS to determine therapeutic interventions and antibiotic stewardship.
Megan Daniele CVM_Daniele - CV1.pdf
Figure 2: Highest nSOFA and Outcome