Comparison of Different Neonatal Disease Severity Scoring Systems for Predicting Mortality Risk in Neonatal Intensive Care Unit: A Cross-sectional Study

Introduction: To predict the risk of mortality among neonates, birth weight and gestational age have previously been used. However, a single parameter was inadequate to predict the severity of illness and outcomes for neonates. Therefore, a combination of parameters has been employed to create disease severity scoring systems aimed at predicting mortality. Consequently, various scoring systems have been developed in recent years. There is a need to assess the severity of illness in newborns, provide prognostic information to parents and formulate a new disease severity scoring system for the Neonatal Intensive Care Unit (NICU) unit. Aim: To evaluate and compare the predictive accuracy of neonatal disease severity scoring systems {Score for Neonatal Acute Physiology-Perinatal Extension II (SNAP-PE II), Transport Risk Index of Physiologic Stability (TRIPS), Mortality Index for Neonatal Transportation (MINT), Transport Related Mortality Score (TREMS) and Sick Neonate Score (SNS)} in assessing neonatal mortality risk upon admission to the NICU. Materials and Methods: This analytical cross-sectional study was conducted between September 2023 and August 2024 at Level II and Level III NICU of Malabar Medical College Hospital and Research Centre, Ulliyeri, Kozhikode, Kerala, India. Data on neonatal characteristics at admission, perinatal characteristics, maternal characteristics and transport information for 400 newborns who met the inclusion criteria were collected. Each parameter from the five disease severity scoring systems was obtained and recorded. The scores for SNAP-PE II, TRIPS, MINT, TREMS and SNS for all cases were then calculated. At the end of the seventh day of admission, the outcomes were measured as survivors and non survivors. Results: Out of 390 neonates studied, 330 (84.6%) were survivors and 60 (15.4%) were non survivors. The median and interquartile range of the SNAP-PE II, TRIPS, MINT, TREMS and SNS scoring systems were higher for non survivors than for survivors. Key predictors of mortality, including admission weight, birth weight, 1-minute and 5-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores, gestational age and the need for resuscitation, were identified as strong indicators of mortality, regardless of age at admission. Conclusion: Neonatal disease severity scoring systems provide prognostic information, which assists in counselling parents. They also facilitate the evaluation of transport systems.