Evaluation of TOPS score as predictor for outcome in sick newborns

Abstract

Background: Multiple parameters have been developed to prognosticate the outcomes of critically ill newborns admitted in NICUs. The objective of this study is to predict the outcome of newborns admitted in NICU using a simple but efficient score, TOPS score, involving alteration of physiological parameters. Aim of this study was to evaluate role of TOPS score in predicting mortality in sick neonates.Methods: The variables assessed under TOPS score on arrival for all subjects were: Temperature, Oxygen Saturation, Perfusion and blood glucose reading <45 mg/dl. All affected neonates were given treatment as per NICU protocol and outcome was assessed in terms of mortality or discharge using TOPS score. It was prospective study conducted at NICU, Department of Pediatrics, GMERS medical college and general hospital, Gotri, Vadodara. Study population was all admitted neonates aged <28 days at NICU.Results: Mean age of presentation of all cases was 2.8±3.58 days. Hypothermia on admission was observed in 63.3% cases. 40.8% cases had hypoxia. 26.5% neonates recorded poor perfusion. Mortality observed in hypoxic group was 51.7% followed by hypothermic group (46.9%). Highest strength of association was found for poor perfusion, mortality (87.5%) and OR-33.406. TOPS score was observed to be statistically significant (X2 value is 63.27, p < 0.05) as predictor of mortality. Thus, mortality rate increased with increasing no. of altered TOPS parameters. Regression analysis showed three factors (hypothermia, hypoxia, prolonged CRT) which are consistently associated with p value ≤ 0.05 for each variable and can be used to predict mortality.Conclusions: All parameters in TOPS score are physiologically important and each parameter carries an independent risk associated with mortality. It is important to note that multiple parameters affected increases the risk. TOPS score is a simple, basic and effective tool to guide about the condition of new born at admission and outcome. of neonatal mortality.

TOPS score (T-temperature, O-Oxygen saturation, P- Perfusion, S- Sugar) on admission in transported neonates to tertiary care hospital

“…Only 33% of our neonates were found to be hypoxic which closely matches studies conducted by Pathak et al 9 (27.8%), Begum et al(28.2%), 13 Sheth M.N. et al(29.5%) 14 while 51.6% were hypoxic in the study by Bagel et al 8 Perfusion as per prolonged CRT was found deranged in 43% of our study population and it matches with Pathak et al 9 33.9%, while rest of the studies reflect a much better state of perfusion of the babies on arrival. The issue of hypoglycaemia again is higher in our neonates(17.6%) almost matching the 22% in Pathak et al 9 study, while remain a long way from the single digit proportions of our other compared studies.…”

Neonatal Transport Facilities and Its Effect on Outcome: An Experience from Tertiary Care Hospital of Central Gujarat

“…Normal saturation on arrival (≥ 90%) was significantly associated with higher chances of survival (62% vs 16.7%, p =0.04). Studies by Sheth and Pandya, 12 Ayesha Begum et al, 13 and Chedda et al 14 found similar findings in their study as well where hypoxia on arrival was associated with higher chances of mortality.…”

“…CRT of <3 seconds on arrival was significantly associated with more chances of survival (80% vs 33.3%, p =0.013). Sheth and Pandya 12 conducted a study where they evaluated the outcome of sick newborns using Temperature, oxygenation, capillary refill time (perfusion), and blood sugar score and found that the maximum odds for mortality was observed with poor perfusion (odds ratio = 33.406 with a p value < 0.05). Delayed CRT is a marker for poor perfusion and can be due to multiple reasons such as hypovolemia, peripheral vasodilatation, and decreased cardiac output.…”

Post-transport TOPS score as a predictive marker of mortality among transported neonates and its comparative analysis with SNAP-II PE

“…The instruments used for measuring the TOPS are of standard and calibrated by the manufacturer. The instruments used for measuring TOPS score are as follows, Temperature measured by the Omron digital thermometer, Oxygen saturation by Masimo pulse oximeter, Blood sugar was evaluated by Dr Morepen Gluco one Glucometer, Perfusion done through the clinical assessment by testing over sternum/sole [ 11 , 14 ]. Figure 1 represents the aetiology of referral in detail.…”

“…The variables which are used for the scoring purpose are less susceptible to subjective variation and each variable has an independent risk associated with mortality. On the other hand, the TOPS scoring method demands large population size when compared to SNAP II and do not consider the perinatal factors [ 8 , 14 , 15 ].…”