Possibilities of using the pSOFA rating scale for the diagnosis of sepsis in newborns

In 2016, experts from the Society Critical Care Medicine and the European Society Intensive Care Medicine proposed a new terminology and definitions of sepsis ‒ «The Third International Consensus on the Definition of Sepsis and Septic Shock (Sepsis-3)». Based on the new concept, sepsis should be considered as a life-threatening acute organ dysfunction resulting from dysregulation of the response of a macroorganism to infection, which is manifested by damage to its own tissues and organs. In this case, the diagnostic criteria for sepsis are suspected or documented infection in combination with acute organ dysfunction, the development of which is concluded by the SOFA index by 2 points or more from the baseline value. In the context of a new concept of sepsis for assessing organ dysfunction in pediatric patients, including newborns, the age-adapted pSOFA (pediatric SOFA) scale was proposed. Purpose of the study: to evaluate the diagnostic possibilities of using the pSOFA rating scale in sepsis in newborns. To achieve this goal, the patients of the intensive care unit and intensive care unit for newborns were examined. Study design ‒ prospective, observational, single-center study. Inclusion criteria ‒ newborns with a presumptive or established clinical diagnosis of «sepsis» in combination with progressive organ dysfunction. A total of 18 newborns with neonatal sepsis were under observation. The gestational age of the patients was 30,7 ± 4,5 weeks, the body weight at birth was 1310 ± 678 g. Early neonatal sepsis was recorded in 11,1% of cases, late neonatal ‒ in 88,9%. Of the leading foci of infection in patients, the following were most often recorded: pneumonia (77,7%), necrotizing enterocolitis (66,1%) and meningoencephalitis (22,2%). A statistically significant difference in the pSOFA diagnostic score was determined in patients with sepsis upon admission to the ICU and in the dynamics of the disease with an increase in organ dysfunction (two-stage measurement). There was an increase in the total score of the diagnostic assessment on the pSOFA scale with an increase in organ dysfunction in patients with sepsis in comparison with the total score on admission (p < 0,05). These data indicate that an increase in organ dysfunction in newborns with suspected or documented infection by 2 points or more than the baseline (baseline) value on the pSOFA scale makes it possible to diagnose sepsis. The mean value of the total score with the increase in organ dysfunction on the pSOFA scale did not differ statistically in surviving patients with sepsis and in those who died. For the diagnosis of sepsis in newborns, it is advisable to use the pSOFA scale.

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