Modified Sick Neonatal Score in Predicting Outcomes of Neonates Admitted to the NICU at a Tertiary Care Center in Northern India

Background Early identification of critically ill neonates is essential for timely intervention and improved outcomes, particularly in resource-limited settings. Several neonatal illness severity scoring systems have been developed to predict mortality; however, many rely on laboratory investigations and complex calculations, limiting their applicability in low-resource health care settings. The Modified Sick Neonatal Score (MSNS) is a simple bedside clinical scoring system based on easily measurable parameters that may help predict neonatal mortality and severity of illness. This study aimed to assess the utility and predictive accuracy of the MSNS in neonates admitted to a tertiary care NICU in Northern India. Materials and methods This prospective observational study was conducted in the NICU of a tertiary care center in North India over 18 months. A total of 190 neonates aged ≤28 days were enrolled using systematic sampling. The MSNS was calculated at admission for each neonate. Clinical outcomes, including mortality, need for respiratory support, inotropic support, and duration of hospital stay, were recorded. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 26.0 (released 2018; IBM Corp., Armonk, NY, USA). A p-value < 0.05 was considered statistically significant. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive accuracy of MSNS for mortality. Results Out of 190 neonates, 30/190 (15.8%) died, while 160/190 (84.2%) were discharged. The mean MSNS score was significantly lower among non-survivors compared with survivors (7.87 ± 1.70 vs 10.80 ± 1.75; p < 0.001). Neonates requiring respiratory and inotropic support had significantly lower MSNS scores. The area under the ROC curve for MSNS in predicting mortality was 0.894. At a cutoff value of <10, MSNS demonstrated a sensitivity of 90.0%, a specificity of 77.5%, a positive predictive value of 42.9%, a negative predictive value of 97.6%, and an overall accuracy of 79.5% for predicting neonatal mortality. Conclusions The MSNS is a simple and practical bedside tool with strong predictive ability for neonatal mortality and severity of illness. Lower MSNS scores were significantly associated with mortality, need for respiratory support, and inotropic requirement among admitted neonates. The MSNS demonstrated high sensitivity and negative predictive value, supporting its reliability for the early identification of high-risk neonates. Its ease of application without laboratory investigations makes it particularly valuable for timely clinical decision-making in resource-limited settings.