Modified NEOMOD score as a neonatal mortality prediction tool in a medium-income country: A validation diagnostic test study

Laura Torres-Canchala; Karen Molina; Mayra Barco; Laura Soto; Adriana Ballesteros; Alberto F García

doi:10.1002/hsr2.1065

Modified NEOMOD score as a neonatal mortality prediction tool in a medium-income country: A validation diagnostic test study

Health Sci Rep. 2023 May 17;6(5):e1065. doi: 10.1002/hsr2.1065. eCollection 2023 May.

Authors

Laura Torres-Canchala^{1

2}, Karen Molina², Mayra Barco², Laura Soto², Adriana Ballesteros³, Alberto F García⁴

Affiliations

¹ Clinical Research Center Fundación Valle del Lili Cali Colombia.
² Facultad de Ciencias de la Salud Universidad Icesi Cali Colombia.
³ Newborn Unit Fundación Valle del Lili Cali Colombia.
⁴ Department of Surgery Fundación Valle del Lili Cali Colombia.

Abstract

Background and aims: Multiple organ dysfunction (MOD) is a potentially reversible physiological disorder that involves two or more systems. Modified NEOMOD (Neonatal Multiple Organ Dysfunction score) scale could be a useful instrument to measure MOD and predict mortality. Our aim was to validate modified NEOMOD in patients from a neonatal intensive care unit (NICU) of a middle-income country.

Methods: Diagnostic test study. Preterm newborns admitted NICU were included. Daily values were collected from birthday to Day 14. MOD was defined as at least one point in two or more systems. The lowest score is 0 and the maximum is 16. The outcome variable was mortality. Secondary outcomes were bronchopulmonary dysplasia, retinopathy of prematurity (ROP), late-onset neonatal sepsis (LONS), intraventricular hemorrhage (IVH) and length of hospital stay. Area under the curve (AUC) and Hosmer-Lemeshow test were calculated to evaluate scale discrimination and calibration. Logistic regression was used to estimate the association between daily modified NEOMOD score and death.

Results: We included 273 patients who met the inclusion criteria. MOD incidence was 74.4%. The median gestational age in patients with MOD was 30 (interquartile range [IQR]: 27-33) and in patients without MOD it was 32 (IQR: 31-33) (p < 0.001). There were 40 deaths (14.6%), 38 (18.7%) from the MOD group and 2 (2.9%) from non-MOD group. On accumulated Day 7, AUC was 0.89 (95% confidence interval [CI]: 0.83-0.95). Modified NEOMOD had good calibration (X ² = 2.94, p = 0.982). DBP (12.8% vs. 2.9%, p = 0.001), ROP (3.9% vs. 0%, p = 0.090), IVH (33% vs. 12.9%, p < 0.001), and LONS (36.5% vs. 8.6%, p < 0.001) frequency was higher in the MOD group than non-MOD group. Length of hospital stay also was higher in MOD group (median 21 days [IQR 7-44] vs. median 5 days [IQR 4-9], p = 0.004).

Conclusion: Modified NEOMOD scale presents good discrimination and calibration for death in preterm children. This scale could help in clinical decision-making in real-time.

Keywords: infant; modified NEOMOD; mortality; neonatal intensive care; preterm; validation.