Utility of the Modified Sick Neonatal Score to Predict the Mortality in Outborn Neonates: A Cohort Study
Introduction: Illness severity scoring systems are essential tools for reducing mortality by identifying disease severity and providing early intervention. The application of the Modified Sick Neonatal Score (MSNS) in resource-limited settings has been studied in inborn neonates, but there is a...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2023-10-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/18602/64515_CE[Ra1]_F[SK]_QC(KK_RDW_IS)_PF1(RI_KM_OM)_PFA(RI_KM)_PN(KM).pdf |
| Summary: | Introduction: Illness severity scoring systems are essential
tools for reducing mortality by identifying disease severity and
providing early intervention. The application of the Modified
Sick Neonatal Score (MSNS) in resource-limited settings has
been studied in inborn neonates, but there is a lack of data
regarding outborn neonates.
Aim: To predict mortality in outborn transported neonates by
applying the MSNS score.
Materials and Methods: This cohort study was conducted from
June 2020 to November 2021 in the Department of Paediatrics
at Government Medical College, Nagpur, Maharashtra, India.
Parameters of the MSNS scoring system (respiratory effort, heart
rate, axillary temperature, capillary refilling time, random blood
sugar, oxygen saturation, gestational age, and birth weight) were
evaluated in all admitted outborn neonates upon admission, and
outcomes (discharge or death) were noted. The score and individual
parameters were correlated with the outcome. Chi-square test,
Fischer's-exact test, and Mann-Whitney U test were applied to
statistically analyse the data. A receiver operating curve was plotted
to determine the cut-off value for the score to predict mortality.
Results: In the present study, 866 (58.2%) neonates were male,
while 622 (41.8%) were female, and the mean age at admission
was 43.3±58.9 hours. Nearly two-thirds of the neonates were
born at term, and the mean birth weight was 2191.62±595.47 gm.
A total of 91.7% of the neonates were referred by government
facilities, and 82.8% of the neonates were transported by
ambulance, but only one-third of the ambulance-transported
neonates were accompanied by a health assistant. The mean
traveling distance was 83.57±72.79 km, and the mean transport
duration was 2.14±1.07 hours. The common clinical diagnosis
were sepsis (42.68%), respiratory distress (19.89%), and birth
asphyxia (14.78%). The neonatal mortality rate was 29.3%. The
total MSNS score for neonates who survived was 11.26±2.34,
compared to 8.52±2.23 for the neonates who died (p-value
<0.0001). The sensitivity was 80.5%, with a specificity of 63.1%
and an area under the curve of 0.79 (OR-24.72, 95% CI 0.77-0.81,
p-value <0.001) when using the optimal cut-off score of ≤10.
Conclusion: The MSNS score of ≤10 has better sensitivity and
specificity in predicting neonatal mortality in outborn transported
neonates. |
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| ISSN: | 2249-782X 0973-709X |