Characterization of multiple organ dysfunction syndrome in very low birthweight infants: A new sequential scoring system

To define multiple organ dysfunction in newborns, we established a sequenti al scoring system NEOMOD (Neonatal Multiple Organ Dysfunction Score). It wa s developed to describe the process of increasing physiologic derangement i n critically ill newborns. It provides, during the first 28 days of life, i nformation concerning function of organ systems having a primary influence on mortality in very low birth weight (VLBW) infants. Our scoring system ha s been used in 142 VLBW infants, it evaluates moderate (1 point) or severe dysfunction (2 points) in 7 organ systems (central nervous system, cardiova scular, renal, respiratory, and gastrointestinal systems, and hemocoagulati on and acid-base balance) in 24-h intervals from day 1 to 28 of life. Maxim um possible value of NEOMOD was 14 points. Receiver operating characteristi c curve was used for assessing predictive accuracy of maximum NEOMOD score obtained by daily scoring for mortality rate. AUC (area under curve) attain ed by NEOMOD was 0.95 for mortality within the first 28 days and 0.91 for h ospital mortality, respectively. In the study group, NEOMOD score of greate r than or equal to9 was associated with 100% mortality. An analysis of spec ific organ dysfunctions in the non-survivors group (n = 16) disclosed, in a ll patients. dysfunction of more than two organ systems 24 h before death. Similar to critically ill adults, secondary multiple organ dysfunction can be described also in a majority of critically ill VLBW infants. NEOMOD scor es may help to evaluate daily the severity of the syndrome and risk of deat h.