A Neonatal Sequential Organ Failure Assessment Score Predicts Mortality to Late-Onset Sepsis in Preterm Very Low Birth Weight Infants

OBJECTIVE: An operational definition of organ dysfunction applicable to neonates that predicts mortality in the setting of infection is lacking. We determined the utility of an objective, electronic health record (EHR)-automated, neonatal sequential organ failure assessment (nSOFA) score to predict mortality from late-onset sepsis (LOS) in premature, very low birth weight (VLBW) infants. METHODS: Retrospective, single-center study of bacteremic preterm VLBW newborns admitted between 2012–2016. nSOFA scores were derived for patients with LOS at multiple timepoints surrounding the sepsis evaluation. RESULTS: nSOFA scores at evaluation and at all points measured after evaluation were different between survivors and non-survivors. Among patients with an nSOFA score of > 4, mortality was higher at evaluation (13% vs 67%, p<0.001), +6 hours (15% vs 64%, p=0.002), and +12 hours (7% vs 71%, p<0.001) as compared to patients with a score of ≥4. Receiver operating characteristics area under the curve was 0.77 at evaluation (95% CI 0.62–0.92; p=0.001), 0.78 at +6hrs (0.66–0.92; p<0.001) and 0.93 at +12 hrs (0.86–0.997; p<0.001). CONCLUSIONS: The nSOFA scoring system predicted mortality in VLBW infants with LOS and this automated system was integrated into our EHR. Prediction of LOS mortality is a critical step towards improvements in neonatal sepsis outcomes.