OBJECTIVES: To design and validate an objective clinical scoring system to identify unwell neonates, by using routinely collected bedside observations.
METHODS: A Neonatal Trigger Score (NTS) was designed by using local expert consensus and incorporated into a new observation chart. All neonates >35 weeks’ gestation admitted to the NICU over an 18-month period, and an age-matched “well” cohort, were retrospectively scored by using the newly constructed NTS and all established pediatric early warning system (PEWS) scores.
RESULTS: Scores were calculated for 485 neonates. The NTS score area under the receiver operating characteristic curve was 0.924 with a score of 2 or more predicting need for admission to the NICU with 77% sensitivity and 97% specificity. Neonates scoring ≥2 had increased odds of needing intensive care (odds ratio [OR] 48.7, 95% confidence interval [CI] 27.5–86.3), intravenous fluids (OR 48.1, 95% CI 23.9–96.9), and continuous positive airway pressure (OR 29.5, 95% CI 6.9–125.8). The NTS was more sensitive than currently established PEWS scores.
CONCLUSIONS: The NTS observation chart acts as an adjunct to clinical assessment, highlighting unwell neonates. Its simplicity allows successful and safe use by nonpediatric specialists. NTS out-performed PEWS, with significantly better sensitivity, particularly in neonates who deteriorated within the first 12 hours after birth (P < .001) or in neonates with sepsis or respiratory symptoms (P < .001). Neonates with a score of 1 should be reviewed and those scoring ≥2 should be considered for NICU admission for further management.
- AUC —
- area under the curve
- CI —
- confidence interval
- EWS —
- early warning system
- NTS —
- Neonatal Trigger Score
- OR —
- odds ratio
- PEWS —
- pediatric early warning system
- ROC —
- receiver operating characteristic
- Accepted October 25, 2012.
- Copyright © 2013 by the American Academy of Pediatrics