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The neonatal SOFA score in very preterm neonates with early-onset sepsis

Pediatric Research (2025)Cite this article

Abstract

Background

Sepsis is associated with increased neonatal morbidity and mortality. The Neonatal Sequential Organ Failure Assessment (nSOFA) score was developed as a tool to assess neonates with late-onset sepsis (LOS). Absolute values and changes in nSOFA scores are associated with mortality in LOS. Few studies have investigated the nSOFA score in neonatal early-onset sepsis (EOS).

This study assesses the relationship of the nSOFA score with morbidity in preterm neonates with EOS.

Methods

Retrospective, single-center, cohort study. nSOFA scores were determined for very preterm neonates at seven time points within the first 36 hours of life. Peak and median nSOFA scores were compared between (i) survivors with versus without major morbidity (ii) survivors without major morbidity versus the combined outcome of mortality or major morbidity and (iii) survivors versus non-survivors.

Results

Peak and median nSOFA scores were significantly higher in survivors with versus without major morbidity. That was also true for the combined outcome of mortality or major morbidity. Peak and median nSOFA scores trended higher in non-survivors versus survivors.

Conclusions

The nSOFA score discriminates between very preterm neonates likely (versus unlikely) to develop major morbidity. The nSOFA score may have applicability as an assessment tool in neonatal EOS.

Impact

  • The neonatal Sequential Organ Failure Assessment (nSOFA) score provides an operationalized assessment of organ dysfunction in late-onset neonatal sepsis. This study demonstrates the nSOFA score’s utility in early-onset sepsis (EOS).

  • This study provides data to support the nSOFA score’s utility in discriminating major morbidity and mortality in neonates < 32 weeks gestational age with EOS. A higher nSOFA score was associated with increased morbidity in neonates < 32 weeks gestational age with EOS.

  • A validated nSOFA score for EOS has the potential to improve prognostication and provide a basis for risk-stratifying neonates with EOS.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors greatly appreciate David Bateman for his guidance regarding statistical analysis as well as the NYP Pediatrics Department and the Division of Neonatology for institutional support.

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Authors and Affiliations

  1. Division of Neonatology, New York-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA

    Megan Tagerman

  2. Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA

    Rakesh Sahni & Richard Polin

Authors
  1. Megan Tagerman
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  2. Rakesh Sahni
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  3. Richard Polin
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Contributions

Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; - Drs. Tagerman, Sahni, Polin. Drafting the article or revising it critically for important intellectual content; and - Drs. Tagerman, Sahni, Polin. Final approval of the version to be published. - Drs. Tagerman, Sahni, Polin.

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Correspondence to Megan Tagerman.

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Tagerman, M., Sahni, R. & Polin, R. The neonatal SOFA score in very preterm neonates with early-onset sepsis. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04068-z

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