Neonatal Sequential Organ Failure Assessment (nSOFA) Score: A Reliable Tool for Predicting Outcomes in Neonates with Early-Onset Sepsis.

INTRODUCTION: The nSOFA score has been validated in late-onset sepsis. However, evidence regarding its performance in early-onset sepsis remains limited. This study evaluated the utility of the nSOFA score for predicting mortality in neonates with EOS. METHODS: This single-center prospective study was conducted on neonates with EOS admitted to the neonatal intensive care unit. The nSOFA score included respiratory function (SpO₂/FiO₂ ratio and ventilation need), cardiovascular status (inotropes or shock), and platelet count. All neonates were monitored for the need for respiratory support, inotropes, and corticosteroids, as well as for the presence and severity of thrombocytopenia. This score was assessed at three time points: at admission (T₀), 24 hours, and 48 hours. RESULTS: A total of 110 neonates with culture-proven EOS were analyzed. The median gestational age was 35 weeks, mean birth weight was 2054 g, and 78.2% were preterm. Overall mortality was 23.6% (n=26). Non-survivors had significantly higher nSOFA scores at all-time points (p<0.001). The area under the curve (AUC) for mortality prediction was 0.977 at baseline, 0.992 at 24 hours, and 0.998 at 48 hours. Severe thrombocytopenia, birth weight <1500 g, mechanical ventilation, baseline nSOFA >7.5, and a rise in nSOFA ≥2 points were independently associated with mortality (p<0.001). An nSOFA cut-off ≥7.5 (Youden index J = 0.887) showed 92.3% sensitivity and 96.4% specificity for predicting mortality. CONCLUSION: The nSOFA score reliably predicts mortality in neonates with EOS and demonstrates consistent performance across all assessed time points.