Retrospective Evaluation of a New Neonatal Trigger Score

Abstract

The NTS observation chart acts as an adjunct to clinical assessment, highlighting unwell neonates. Its simplicity allows successful and safe use by nonpediatric specialists. NTS out-performed PEWS, with significantly better sensitivity, particularly in neonates who deteriorated within the first 12 hours after birth (P < .001) or in neonates with sepsis or respiratory symptoms (P < .001). Neonates with a score of 1 should be reviewed and those scoring ≥2 should be considered for NICU admission for further management.

Respiratory distress in the neonate: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data

“…In addition to respiratory specific scoring systems, there are also general neonatal illness scoring systems. These include the Sick Neonate Score (SNS) [31] , the Score for Neonatal Acute Physiology II (SNAP-II) [32] , and the Neonatal Trigger Score (NTS) [33] (see Appendix B and Table 2 ). Although by definition these scores are more representative of overall neonatal illness, each does take respiratory symptoms into account, and therefore may also help determine the presence of respiratory distress in the neonate.…”

“…SNS is a clinical score that was developed to assess neonatal illness in resource limited settings [31] . SNAP-II and NTS require 12 h of data collection, and SNAP-II requires assessment of urine output and a blood gas, which may make it more difficult to implement these scoring systems in some settings [11] , [32] , [33] .…”

Predictive monitoring for sepsis and necrotizing enterocolitis to prevent shock

“…For infants and children, the Pediatric Early Warning System (PEWS) was developed as a tool for bedside caregivers to assess cardiorespiratory and neurologic deterioration but its impact on sepsis-related outcomes has not been tested [49]. With regard to neonates, a "Neonatal Trigger Score" based on level of consciousness, respiratory rate, heart rate, and temperature identified infants >35 weeks of gestation who subsequently required intravenous fluids, respiratory support, and/or NICU admission [50]. Although none of these scores addresses early detection of sepsis in preterm infants in the NICU, they illustrate the concepts of combining analysis of vital signs and other parameters into a score that triggers closer evaluation of patients to prevent further deterioration.…”

Prospective evaluation of the Whitt Neonatal Trigger Score in an ‘at‐risk’ neonatal population

“…Although a couple have been proposed previously, none had been validated or extensively studied, with no statistical analysis of score sensitivities or specificities, and the established Paediatric Early Warning System (PEWS) scores either demonstrated poor sensitivity in detecting unwell neonates or were overly complicated for a non‐specialist environment. Therefore, a neonatal‐specific score (Whitt Neonatal Trigger Score (W‐NTS)) was developed in 2010 to provide an objective measure of clinical status using routine bedside observations …”

“…For retrospective evaluation, scores were calculated for 485 neonates on the PNW, demonstrating the high sensitivity and specificity of W‐NTS in detecting unwell neonates, with a score cut‐off of 2 suggested for considering intensive care unit (ICU) admission. Neonates scoring 2 or more had increased odds of needing intensive care (odds ratio (OR) 48.7, 95% confidence interval (CI) 27.5–86.3), intravenous fluids (OR 48.1, 95% CI 23.9–96.9) and continuous positive airway pressure (CPAP; OR 29.5, 95% CI 6.9–125.8) . W‐NTS also outperformed the four most commonly used PEWS with increased sensitivity (77% vs. 1–63%) and no loss of specificity (97% vs. 98–100%), and it is currently in use in hospitals across Europe and the USA.…”