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Abstract
Aims At present there is no published validated clinical scoring system for neonates. We aimed to design and validate an objective clinical scoring system to identify unwell neonates, using routinely collected bedside observations.
Methods A Neonatal Trigger Score (NTS) was designed using local expert consensus and incorporated into a new observation chart (see Figure 1). All neonates over 35 weeks gestation admitted to the Neonatal Intensive Care Unit (NICU) over an 18-month period, and an age-matched “well” cohort, were retrospectively scored using the newly constructed NTS and all established Paediatric Early Warning System (PEWS) scores.
Results Scores were calculated for 485 neonates. The NTS score area under the receiver operating characteristic (ROC) curve was 0.924 with a score of 2 or more predicting need for admission to NICU with 77% sensitivity and 97% specificity. Neonates scoring 2 or more had increased odds of needing intensive care (odds ratio [OR] 48.7, 95% confidence interval [CI] 27.5–86.3), intravenous fluids (OR 48.1, 95% CI 23.9–96.9) and continuous positive airway pressure (OR 29.5, 95% CI 6.9–125.8). The NTS was more sensitive than currently established PEWS scores.
Consideration was also given to which scoring parameters were the most predictive. We postulated that performance of the score might be improved by excluding low temperature as a scoring parameter. However, because of recent concerns over hypothermia being an unrecognised sign of sepsis it was felt not appropriate to completely omit a low temperature. This score adjustment resulted in an area under the ROC curve of 0.936.
Conclusions The NTS observation chart acts as an adjunct to clinical assessment, highlighting unwell neonates. Its simplicity allows successful and safe use by non-paediatric specialists. NTS out-performed PEWS, with significantly better sensitivity, particularly in neonates who deteriorated within the first 12 hours after birth (p < 0.001) or in neonates with sepsis or respiratory symptoms (p < 0.001). Neonates with a score of 1 should be reviewed and those scoring 2 or more should be considered for NICU admission for further management.
