Aims To prospectively evaluate the Neonatal Trigger Score (NTS) to determine optimum threshold scores for medical intervention and intensive care (ICU) admission.
Methods All neonates on the postnatal ward with a set of pre-defined risk factors were scored on the NTS (Figure 1). Neonates were divided into three groups: “unwell” admitted to NICU, “well” who remained on the postnatal ward receiving standard care and “intervention” who received antibiotics but did not require admission to NICU.
Results A total of 3,315 scores from 455 neonates were collected. The Neonatal Trigger Score (NTS) score area under the receiver operating characteristic curve (AUC ROC) was 0.968 with a score of 2 or more predicting NICU admission with 82.5% sensitivity and 95.0% specificity (Table 2). Adopting a cut-off score of 2 for admission would significantly improve speed to admission (11.6 vs 6.9 h, P 0.037). A score of 0 was strongly predictive of being well enough to remain on the postnatal ward without intervention (OR 565.6, P < 0.001) and a score of 1 or more predicted need for intravenous antibiotics with 100.0% sensitivity and 86.1% specificity (AUC ROC 0.977).
Conclusions The NTS observation chart, previously shown to outperform existing paediatric early warning scores, acts well as an adjunct to clinical assessment on the postnatal ward with its simplicity allowing successful and safe use by non-paediatric specialists. We recommend neonates scoring 1 should be reviewed, with a septic screen and commencement of antibiotic therapy considered, while those scoring 2 or more should be strongly considered for NICU admission for further management.
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