Neonatal Sequential Organ Failure Assessment

The nSOFA components and scoring paradigms were modeled after the adult SOFA.^{12 (link),13 (link)} The nSOFA uses only objective and available clinical standard-of-care data to provide an operational definition of organ dysfunction that facilitates mortality risk stratification among VLBW infants with unequivocal LOI (bacteremia or intestinal perforation).^{14 (link)} The nSOFA uses categorical scores (total score range from 0 [best] to 15 [worst]) to objectively describe dynamic changes in (1) receipt of mechanical ventilation and oxygen to maintain a physiologic peripheral saturation (score range, 0-8); (2) inotropic or vasoactive drug support, including the use of corticosteroids for presumed adrenal insufficiency or catecholamine-resistant shock (score range, 0-4); and (3) the presence and severity of thrombocytopenia based on the most recent platelet measure (score range, 0-3) (Table 1; eAppendix in the Supplement).
The nSOFA score was validated in an independent, single-center cohort of infants with LOI.^{14 (link)} In this multicenter, retrospective study to determine the generalizability of the nSOFA, each center identified qualifying infants and calculated the nSOFA score at 9 discrete time points, including and surrounding the LOI episode, using a web-based calculator and data from the electronic health records. The time the blood sample was drawn from the patient represented time 0 (T0). The time points that preceded (T minus 48 hours [T-48], T-24, T-12, and T-6) and followed (T plus 6 hours [T6], T12, T24, and T48) the infection evaluation were based on the progression of organ dysfunction in previous studies.^{14 (link),15 (link)}