Development and Validation of the Neonatal Risk Estimate Score for Children Using Extracorporeal Respiratory Support.

Area of Science:

• Neonatal critical care
• Extracorporeal membrane oxygenation (ECMO)
• Pediatric risk stratification

Background:

• Neonatal respiratory failure requiring ECMO is associated with high mortality.
• Accurate risk assessment is crucial for patient management and performance evaluation.
• Existing scores may not adequately capture severity of illness in this population.

Purpose of the Study:

• To develop and validate the Neonatal Risk Estimate Score for Children Using Extracorporeal Respiratory Support (Neo-RESCUERS).
• To estimate the risk of in-hospital death for neonates before ECMO initiation.
• To provide a tool for severity-of-illness adjustment in neonatal ECMO care.

Main Methods:

• Utilized an international ECMO registry (2008-2013) with 4592 neonates.
• Divided data into derivation (2008-2011) and validation cohorts.
• Developed a parsimonious logistic regression model and evaluated performance using AUC and Hosmer-Lemeshow tests.

Main Results:

• The Neo-RESCUERS score demonstrated good discrimination, with an AUC of 0.78 in the derivation cohort and 0.77 in the validation cohort.
• Observed mortality closely matched predicted mortality across risk deciles, from 7.0% (predicted 4.4%) in the lowest to 65.6% (predicted 67.5%) in the highest.
• Overall in-hospital mortality for neonates receiving ECMO was 31%.

Conclusions:

• The Neo-RESCUERS score provides effective severity-of-illness adjustment for neonatal ECMO patients.
• This validated score can be used to adjust survival data for assessing hospital-level performance in ECMO centers.
• Neo-RESCUERS facilitates more equitable comparisons of outcomes in neonatal respiratory failure care.