Clinical application of neonatal critical illness score

Objective To investigate the significance of neonatal critical illness score (NCIS)(Draft) for treating critically ill neonates. Methods A total of 581 cases of critically ill neonates who were treated in Department of Neonatology, Bazhong Central Hospital of Sichuan Province from May 2012 to May 2015 were selected as research subjects. All the 581 cases met the neonatal critical cases diagnostic criteria in NCIS (Draft) and their clinical data were collected by retrospective method. The single index that matched the index of critically ill neonates of NCIS (Draft) and the score points of inspection items of NCIS for critically ill neonates whose NCIS score ≤90 points were statistically analyzed. According to the prognosis of the 581 cases, they were enrolled into good prognosis group (n=445), and poor prognosis group (n=136). The clinical data between two groups were statistically analyzed. Combined with the results of existing researches and clinical practice, some factors were introduced into multivariate unconditional logistic regression analysis to analyzed the prognostic factors of critically ill neonates. Results ①Among the 581 cases of critically ill neonates, the number of male neonates was higher than female neonates (370∶211). Most neonates were born in 1 d (420 cases, 72.3%), and there were more neonates via cesarean section than those via vaginal delivery (337∶244). And 54.7% (318/581) neonates had at least one high risk factor. The first three diseases of critically ill neonates were neonatal respiratory distress syndrome (NRDS) (32.4%, 188/581), neonatal pneumonia (22.7%, 132/581), and neonatal asphyxia (15.8%, 92/581). ②Among the 581 cases of critically ill neonates, 455 cases (78.3%) were diagnosed as neonatal critical cases by single index of NCIS (Draft), which were mostly presented as requiring tracheal intubation or repeating apnea without response to stimulation (59.3%, 270/455), severe hyper bilirubinemia (16.7%, 76/455), and hypoglycemia (10.1%, 46/455). Among the 581 cases of critically ill neonates, 585 cases (96.0%) were diagnosed as neonatal critical cases by NCIS score ≤ 90 points. And the first three inspection items with most easily deducted were pH value ≤7.25 or ≥7.50 (31.5%, 176/558), respiratory rate ≤ 25 time/min or ≥ 60 time/min (18.1%, 101/558), and partial pressure of oxygen in artery (PaO2) ≤ 60 mmHg (1 mmHg=0.133 kPa) (16.8%, 94/558). ③There were no statistical differences between good prognosis group and poor prognosis group in the gender ratio, onset age, and gestational age (P>0.05). Compared with poor prognosis group, the birth weight in good prognosis group was heavier, the hospitalization time was longer, cesarean delivery rate was higher, but the proportion of very critical newborns (NCIS score< 70 points) in good prognosis group was lower, and all the differences were statistically significant (P<0.05). ④The results of multivariate unconditional logistic regression analysis indicated that birth weight, hospitalization time and NCIS score were independent factors affecting the prognosis of critically ill newborns (OR=2.528, 95%CI: 1.178-5.426, P=0.017; OR=76.736, 95%CI: 27.279-215.858, P<0.001; OR=106.697, 95%CI: 43.952-259.019, P<0.001). Conclusions The single index and NCIS score in NCIS (Draft) can reflect the state of neonatal lesions accurately and effectively. So this method can guide the treatment and prognosis assessment of critically ill newborns and is beneficial for building referral mechanism in primary hospital and emergency access for critical neonates. Thus it can improve the rate of successful rescue and reduce the mortality rate of critically ill neonates. Key words: Critical illness; Neonatal critical illness score; Prognosis; Clinical application; Infant, newborn