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Neonatal Sequential Organ Failure Assessment as a late-onset sepsis mortality predictor in very low birth weight newborns: a Brazilian cohort study

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Abstract

Death is a frequent occurrence in late-onset neonatal sepsis (LOS). We aimed to evaluate if the Neonatal Sequential Organ Failure Assessment (nSOFA) is associated with mortality due to LOS in very low birth weight (VLBW) infants. This is a single-center Brazilian cohort study including VLBW infants admitted between 2006 and 2020 who were diagnosed with LOS caused by Staphylococcus aureus, Enterococcus sp or Gram-negative bacteria. The primary outcome was mortality associated with sepsis. Two groups of patients—survivors and non-survivors—were compared regarding descriptive maternal and neonatal variables and the nSOFA score, evaluated at nine moments, from 48 hours before the diagnosis of sepsis to 48 hours later (T-48, T-24, T-12, T-6, T0, T+6, T+12, T+24, T+48). Diagnostic accuracy was expressed as the area under the curve (AUC). Among the 1574 VLBW infants hospitalized in the period, 114 episodes of culture-confirmed LOS occurred. There were 21 sepsis-related deaths (18.4%), mostly from Gram-negative bacteria and Enterococcus sp. There were no statistically significant differences between the groups regarding maternal and neonatal variables. Median nSOFA was significantly higher in the non-survivor group at all time points (range 2 to 13 versus 1 to 3). In the logistic regression analysis, each increment of one point in the score significantly increases the risk of death in eight of the nine moments, but no difference was found in T-24. Time T-6 had the best accuracy (88.1%).

   Conclusion: The nSOFA score was significantly associated with the risk of death from LOS in VLBW infants.

What is Known:

• The neonatal sepsis may result in organ dysfunction and death, and it is important to find indicators that could identify this clinical progression.

• The nSOFA score was proposed in 2020 to predict mortality from LOS, but since it is recent and still in the research phase, further studies are important to improve it before being widely used in clinical practice.

What is New:

• We showed a significative association between higher nSOFA scores and mortality. Our results corroborate the validity and the importance of the nSOFA score and highlight its high NPV.

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Data availability

The data that support the findings of this study are available from the corresponding author, BBPL, upon reasonable request.

Abbreviations

AUC:

Area under the curve

CA-BSI:

Catheter-associated bloodstream infection

CI:

Confidence interval

CoNS:

Coagulase-negative staphylococci

CSF:

Cerebrospinal fluid

FiO2:

Fraction of inspired oxygen

GNB:

Gram-negative bacteria

ICU:

Intensive Care Unit

IQR:

Interquartile range

LOS:

Late-onset neonatal sepsis

NEC:

Necrotizing enterocolitis

NPV:

Negative predictive value

nSOFA:

Neonatal Sequential Organ Failure Assessment

OR:

Odds ratio

PPV:

Positive predictive value

pSOFA:

Pediatric Sequential Organ Failure Assessment

ROC:

Receiver Operating Characteristic

SGA:

Small for gestational age

SIP:

Spontaneous intestinal perforation

SNAPPE-II:

Score for Neonatal Acute Physiology with Perinatal Extension II

SOFA:

Sequential Organ Failure Assessment

SpO2:

Oxygen saturation

VLBW:

Very low birth weight

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Acknowledgments

We would like to thank the staff of the Women’s Hospital—State University of Campinas, for their assistance in providing us with the resources we needed to develop this research.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Pediatrics, State University of Campinas – Unicamp, School of Medical Sciences, Campinas, São Paulo, Brazil

    Bárbara B. P. Lobo, Sergio T. M. Marba & Jamil P. S. Caldas

  2. State University of Campinas – Unicamp, Women’s Hospital, São Paulo, Campinas, Brazil

    Helymar C. Machado

Authors
  1. Bárbara B. P. Lobo
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  2. Sergio T. M. Marba
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  3. Helymar C. Machado
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Contributions

Bárbara Barros Pereira Lobo and Jamil Pedro de Siqueira Caldas have participated in the concept and design, collection, analysis and interpretation of data, and drafting and revising the manuscript. All other authors have participated in the design of the study, interpretation of data and revising the manuscript. All authors listed on the manuscript approved the submission of this version of the manuscript and take full responsibility for the manuscript.

Corresponding author

Correspondence to Bárbara B. P. Lobo.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the State University of Campinas.

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The informed consent was waived by the Institutional Review Board since this was a retrospective analysis of existing clinical data.

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The informed consent was waived by the Institutional Review Board since this was a retrospective analysis of existing clinical data.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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Lobo, B.B.P., Marba, S.T.M., Machado, H.C. et al. Neonatal Sequential Organ Failure Assessment as a late-onset sepsis mortality predictor in very low birth weight newborns: a Brazilian cohort study. Eur J Pediatr 181, 3767–3774 (2022). https://doi.org/10.1007/s00431-022-04583-9

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