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Background <p>Neonatal respiratory distress syndrome (NRDS) is one of the most common respiratory diseases in the neonatal period and a major cause of neonatal mortality. Prolonged mechanical ventilation (MV) is associated with adverse outcomes in NRDS patients, highlighting the need for effective early risk stratification tools. The Neonatal Sequential Organ Failure Assessment (nSOFA) score has emerged as a potential predictor of adverse outcomes, but its association with prolonged MV remains unclear.</p> Methods <p>This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care III (MIMIC-III) database, analyzing 642 NRDS infants admitted to the neonatal intensive care unit (NICU) between 2001 and 2012. Patients were divided into two groups based on MV duration: prolonged MV (&gt; 96&#xa0;h) and non-prolonged MV (≤ 96&#xa0;h). The highest nSOFA score within 24&#xa0;h of admission was the primary exposure variable. Covariates included demographic data, clinical characteristics, and laboratory results. A multivariable logistic regression model was used to assess the association between nSOFA scores and prolonged MV. The predictive ability of nSOFA was evaluated using the area under the receiver operating characteristic curve (AUC).</p> Results <p>Of the 642 NRDS infants, 192 (29.9%) required prolonged MV. Each 1-point increase in the nSOFA score was associated with a 29% higher risk of prolonged MV (odds ratio [OR]: 1.29; 95% confidence interval [CI]: 1.16–1.44; <i>p</i> &lt; 0.001). The nSOFA score demonstrated moderate predictive ability (AUC: 0.7245; 95% CI: 68.41%–76.49%), which was significantly better than its respiratory sub-score (AUC: 0.6936; <i>p</i> &lt; 0.001) and comparable to the SOFA score (AUC: 0.7218; <i>p</i> = 0.89). Using an nSOFA cutoff of 3, the sensitivity and specificity for predicting prolonged MV were 64.06% and 70.22%, respectively.</p> Conclusion <p>The nSOFA score is an independent risk factor for prolonged MV in NRDS infants, with moderate predictive ability. Its simplicity and effectiveness make it a valuable tool for early risk stratification in NICUs. Future multicenter studies are needed to validate these findings and explore the potential of dynamic nSOFA monitoring in improving predictive accuracy.</p>

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nSOFA scores predict prolonged mechanical ventilation in neonatal respiratory distress syndrome: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2025年12月17日

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  • Lijuan Wang,
  • You Duan,
  • Xiaohu Zhang,
  • Liang Xie,
  • Hanmin Liu,
  • Yang Liu

摘要

Background

Neonatal respiratory distress syndrome (NRDS) is one of the most common respiratory diseases in the neonatal period and a major cause of neonatal mortality. Prolonged mechanical ventilation (MV) is associated with adverse outcomes in NRDS patients, highlighting the need for effective early risk stratification tools. The Neonatal Sequential Organ Failure Assessment (nSOFA) score has emerged as a potential predictor of adverse outcomes, but its association with prolonged MV remains unclear.

Methods

This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care III (MIMIC-III) database, analyzing 642 NRDS infants admitted to the neonatal intensive care unit (NICU) between 2001 and 2012. Patients were divided into two groups based on MV duration: prolonged MV (> 96 h) and non-prolonged MV (≤ 96 h). The highest nSOFA score within 24 h of admission was the primary exposure variable. Covariates included demographic data, clinical characteristics, and laboratory results. A multivariable logistic regression model was used to assess the association between nSOFA scores and prolonged MV. The predictive ability of nSOFA was evaluated using the area under the receiver operating characteristic curve (AUC).

Results

Of the 642 NRDS infants, 192 (29.9%) required prolonged MV. Each 1-point increase in the nSOFA score was associated with a 29% higher risk of prolonged MV (odds ratio [OR]: 1.29; 95% confidence interval [CI]: 1.16–1.44; p < 0.001). The nSOFA score demonstrated moderate predictive ability (AUC: 0.7245; 95% CI: 68.41%–76.49%), which was significantly better than its respiratory sub-score (AUC: 0.6936; p < 0.001) and comparable to the SOFA score (AUC: 0.7218; p = 0.89). Using an nSOFA cutoff of 3, the sensitivity and specificity for predicting prolonged MV were 64.06% and 70.22%, respectively.

Conclusion

The nSOFA score is an independent risk factor for prolonged MV in NRDS infants, with moderate predictive ability. Its simplicity and effectiveness make it a valuable tool for early risk stratification in NICUs. Future multicenter studies are needed to validate these findings and explore the potential of dynamic nSOFA monitoring in improving predictive accuracy.