"Neo-PIRO": Introducing a Novel Grading System for Surgical Infections of Neonates.

Area of Science:

• Neonatal surgery
• Critical care medicine
• Sepsis quantification

Background:

• Surgical site infection (SSI) quantification is limited.
• Invasive surgical sepsis with systemic effects lacks a standardized quantification method, especially in neonates.
• Existing medical sepsis scoring systems like PIRO are not tailored for surgical neonates.

Purpose of the Study:

• To develop and validate a novel grading system for quantifying neonatal surgical infections.
• To adapt the Predisposing factors, Infection, Response, and Organ failure (PIRO) score for surgical neonates.
• To establish a linear relationship between the grading system's scores and patient outcomes.

Main Methods:

• Modified the Predisposing factors, Infection, Response, and Organ failure (PIRO) score with neonate-specific surgical parameters.
• Developed a three-grade system (Grade I, II, III) for neonatal surgical infections.
• Utilized blinded statistical tests, including the Extended Mantel-Haenszel Chi-square test and Analysis of Variance, to validate the grading system.

Main Results:

• The Neo-PIRO score demonstrated a linear relationship with patient outcomes, hospital stay, deep SSI, and organ dysfunction.
• Higher Neo-PIRO grades correlated with increased probability of mortality.
• Grade I patients experienced shorter hospital stays (P = 0.04) and less organ support/SSI compared to Grade II and III patients.

Conclusions:

• Neo-PIRO is the first scoring system to effectively quantify neonatal surgical infections with a linear relationship between scores and outcomes.
• The system incorporates surgical neonate-specific parameters.
• Future iterations aim to include molecular parameters and regression-selected variables for enhanced accuracy.