Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Early Prediction of Mortality after Birth Asphyxia with the nSOFA

Anne-Kathrin Dathe
,
Anja Stein
ORCID logo ,
Nora Bruns
ORCID logo ,
Elena-Diana Craciun
,
Laura Tuda
,
Johanna Bialas
,
Maire Brasseler
,
Ursula Felderhoff-Müser
,
Britta Hüning
* ORCID logo
Version 1 : Received: 28 April 2023 / Approved: 29 April 2023 / Online: 29 April 2023 (02:52:55 CEST)

A peer-reviewed article of this Preprint also exists.

Dathe, A.-K.; Stein, A.; Bruns, N.; Craciun, E.-D.; Tuda, L.; Bialas, J.; Brasseler, M.; Felderhoff-Mueser, U.; Huening, B.M. Early Prediction of Mortality after Birth Asphyxia with the nSOFA. J. Clin. Med. 2023, 12, 4322. Dathe, A.-K.; Stein, A.; Bruns, N.; Craciun, E.-D.; Tuda, L.; Bialas, J.; Brasseler, M.; Felderhoff-Mueser, U.; Huening, B.M. Early Prediction of Mortality after Birth Asphyxia with the nSOFA. J. Clin. Med. 2023, 12, 4322.

Abstract

(1) Birth asphyxia is the major cause for delivery room resuscitation. Subsequent organ failure and hypoxic-ischemic encephalopathy (HIE) account for 25% of all early postnatal deaths. The neonatal Sequential Organ Failure Assessment (nSOFA) considers platelet count, respiratory and cardiovascular dysfunction in neonates with sepsis. To evaluate whether nSOFA is also a useful predictor for in-hospital mortality in neonates (≥ 36+0 weeks of gestation (GA)) following asphyxia with HIE and therapeutic hypothermia (TH), (2) nSOFA was documented at ≤ 6 hours of life. (3) 65 infants fulfilled inclusion criteria for TH. All but one infant received cardiopulmonary resuscitation and/or respiratory support at birth. nSOFA was lower in survivors (median 0 [IQR 0-2]; n = 56, median GA 39+3, female n = 28 (50%)) than in non-survivors (median 10 [4-12], p < 0.001; n = 9, median GA 38+6, n = 4 (44.4%)). This was also observed for the respiratory (p < 0.001), cardiovascular (p < 0.001), and hematologic sub scores (p = 0.003). The odds ratio for mortality was 1.6 [95% CI = 1.2 – 2.1] per one-point increase in nSOFA. The optimal cut-off value of nSOFA to predict mortality was 3.5 (sensitivity 100.0%, specificity 83.9%). (4) Since early accurate prognosis following asphyxia with HIE and TH is essential to guide end-of-life decisions, nSOFA (≤ 6 hours of life) offers the potential to identify infants at risk of mortality.

Keywords

Birth asphyxia; nSOFA; outcome prediction; neonate; Hypoxic-ischemic encephalopathy (HIE); therapeutic hypothermia; resuscitation; organ dysfunction; biomarker; mortality

Subject

Medicine and Pharmacology, Pediatrics, Perinatology and Child Health

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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