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. 2023 Jun 27;12(13):4322.
doi: 10.3390/jcm12134322.

Early Prediction of Mortality after Birth Asphyxia with the nSOFA

Anne-Kathrin Dathe  1   2   3 , Anja Stein  1   2 , Nora Bruns  1   2 , Elena-Diana Craciun  1   2 , Laura Tuda  1   2 , Johanna Bialas  1   2 , Maire Brasseler  1   2 , Ursula Felderhoff-Mueser  1   2 , Britta M Huening  1   2
Affiliations

Early Prediction of Mortality after Birth Asphyxia with the nSOFA

Anne-Kathrin Dathe et al. J Clin Med. .

Abstract

(1) Birth asphyxia is a major cause of delivery room resuscitation. Subsequent organ failure and hypoxic-ischemic encephalopathy (HIE) account for 25% of all early postnatal deaths. The neonatal sequential organ failure assessment (nSOFA) considers platelet count and respiratory and cardiovascular dysfunction in neonates with sepsis. To evaluate whether nSOFA is also a useful predictor for in-hospital mortality in neonates (≥36 + 0 weeks of gestation (GA)) following asphyxia with HIE and therapeutic hypothermia (TH), (2) nSOFA was documented at ≤6 h of life. (3) A total of 65 infants fulfilled inclusion criteria for TH. All but one infant received cardiopulmonary resuscitation and/or respiratory support at birth. nSOFA was lower in survivors (median 0 [IQR 0-2]; n = 56, median GA 39 + 3, female n = 28 (50%)) than in non-survivors (median 10 [4-12], p < 0.001; n = 9, median GA 38 + 6, n = 4 (44.4%)). This was also observed for the respiratory (p < 0.001), cardiovascular (p < 0.001), and hematologic sub-scores (p = 0.003). The odds ratio for mortality was 1.6 [95% CI = 1.2-2.1] per one-point increase in nSOFA. The optimal cut-off value of nSOFA to predict mortality was 3.5 (sensitivity 100.0%, specificity 83.9%). (4) Since early accurate prognosis following asphyxia with HIE and TH is essential to guide decision making, nSOFA (≤6 h of life) offers the possibility of identifying infants at risk of mortality.

Keywords: birth asphyxia; critical illness assessment; hypoxic–ischemic encephalopathy (HIE); mortality; nSOFA; neonate; organ dysfunction; outcome prediction; resuscitation; therapeutic hypothermia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Inclusion and exclusion criteria. Notes: NICU = neonatal intensive care unit.
Figure 2
Figure 2
Kaplan–Meier curve of time to mortality or discharge (censor) using an nSOFA cut-off level (as reported later) of 3.5. Notes: The length of hospital stay did not differ between groups with an nSOFA value above 3.5 (n = 9, median 9.7 [range 7.0–54.7] days) and below 3.5 (n = 47, median 11.4 [5.4 to 30.2] days).
Figure 3
Figure 3
Distribution (scatter plot) of (a) nSOFA total scores with box plot (median, IQR), (b) respiratory scores, (c) cardiovascular scores, and (d) hematologic scores in survivors and non-survivors. Notes: The area above the nSOFA cut-off value of 3.5 is colored gray. nSOFA = neonatal sequential organ failure assessment; IQR = interquartile range.
Figure 4
Figure 4
Receiver operating characteristics curve for nSOFA to predict non-survival.
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