Retrospective evaluation of a new neonatal trigger score

Area of Science:

• Neonatal care
• Clinical scoring systems
• Pediatric emergency medicine

Background:

• Identifying unwell neonates is crucial for timely intervention.
• Existing early warning systems may lack sensitivity in neonates.
• Bedside observations are routinely collected but require objective interpretation.

Purpose of the Study:

• To design and validate an objective clinical scoring system for identifying unwell neonates.
• To compare the performance of the new Neonatal Trigger Score (NTS) with established Pediatric Early Warning System (PEWS) scores.
• To assess the NTS's utility in predicting the need for NICU admission and interventions.

Main Methods:

• A Neonatal Trigger Score (NTS) was developed using expert consensus and incorporated into a new observation chart.
• Retrospective scoring of neonates (>35 weeks gestation) admitted to the NICU and a matched well cohort using NTS and PEWS.
• Analysis of receiver operating characteristic curves and odds ratios to evaluate predictive performance.

Main Results:

• The NTS demonstrated strong predictive performance with an area under the curve of 0.924.
• A score of ≥2 on the NTS predicted NICU admission with 77% sensitivity and 97% specificity.
• NTS showed significantly higher sensitivity than PEWS, especially for neonates deteriorating within 12 hours of birth or those with sepsis/respiratory symptoms.

Conclusions:

• The NTS observation chart serves as a valuable adjunct to clinical assessment for identifying at-risk neonates.
• The NTS is simple, safe, and effective for use by non-pediatric specialists.
• The NTS outperforms PEWS, recommending review for a score of 1 and consideration for NICU admission for scores ≥2.