A prospective study to evaluate neonatal trigger score as an early warning system in post-natal wards
Keywords:PNW, NTS, Early warning system, NICU
Background: The early postnatal period is a critical phase in newborns as major changes occur in this period. Hence, this study was done to determine the utility of Whitt neonatal trigger score (W-NTS) as a clinical tool.
Methods: A prospective observational study was conducted at Kempegowda institute of medical sciences (KIMS) during the period of December 2019 to June 2021. All neonates admitted in postnatal wards of KIMS hospital during the study period were included. Detailed history was taken and NTS observation and scoring chart was applied.
Results: NTS chart was applied on a total of 750 neonates who fulfilled the inclusion criteria. Out of 750 neonates, 136 (18.1%) triggered the NTS chart. Twenty-one (15.4%%) neonates did not require any medical intervention while 115 (84.6%) required intervention (25 in post-natal wards (PNW) and 90 in neonatal intensive care unit (NICU). In our study, NTS score of 2 has 78.89% sensitivity and 97.27% specificity for admission to NICU while specificity (100%) was high in NTS score of ≥3. The area under the ROC curve for the NTS was 0.99 with confidence interval of 0.98-0.999 and standard error of 0.005 which was statistically significant.
Conclusions: Results from this study shows that W-NTS observation chart acts well as an adjunct to clinical assessment in the PNW, with its simplicity allowing for the successful and safe use.
Stubbe CP, Kruger M, Rutherford P, Gemmell L. Validation of a modified Early Warning Score in medical admissions. Q J Med. 2001;94:521-6.
Duncan H, Hutchison J, Parshuram C. The pediatric early warning system score: A severity of illness score to predict urgent medical need in hospitalised children. J Crit Care. 2006;2:271-8.
Roland D, Madar J, Connolly G. The Newborn Early Warning (NEW) system: development of an at-risk infant intervention system. Infant. 2010;6:116-20.
Holme H, Bhatt R, Koumettou M, Griffin MAS, Winckworth LC. Retrospective evaluation of a new neonatal trigger score. Paediatrics. 2013;131:837-42.
British Association of Perinatal Medicine. Newborn Early Warning Trigger and Track (NEWTT). A framework for practice. 2015.
Ahmed M, Phillips I, Karupaih A, Kamireddy H, Manzoor A. Newborn Observation Track and Trigger (NOTT) Chart. J Coll Phy Surg Pak. 2016; 26:234-7.
Shafi OM, Diego Rondon JD, Gulati G. Can the Pediatric Early Warning Score (PEWS) Predict Hospital Length of Stay? Cureus. 2020;5.
Robinson A, Winckworth LC, Eleftheriou G, Hewitson R, Holme H. Prospective evaluation of the Whitt Neonatal Trigger Score in an ‘at-risk’ neonatal population. J Paediatr Child Health. 2017;53:950-6.
Lambert V, Matthews A, MacDonell R, Fitzsimons J. Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review. BMJ Open. 2017;3:e014497.
Jagt EW. Improving pediatric survival from resuscitation events: the role and organization of hospital-based rapid response systems and code teams. Cur Pediatr Rev. 2013;9:158-74.
Chapman SM, Grocott MP, Franck LS. Systematic review of paediatricalertcriteria for identifying hospitalised children at risk of critical deterioration. Intens Care Med. 2010;36:600-11.
Royal College of Physicians of London. National Early Warning Score (NEWS): standardizing the assessment of acute-illness severity in the NHS. Royal College of Physicians. 2012;29.