Correlation of TOPS Score with the Short-term Outcome of Transported Neonates: An Experience from Resource-limited Settings: A Prospective Observational Study

Document Type : Original Article

Authors

Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India

Abstract

Background: Acute derangements of neonatal physiological parameters, such as temperature, oxygen saturation, skin perfusion, and blood sugar (TOPS parameters), can adversely affect the neonatal outcome. To correlate the TOPS parameter with the short-term outcome of transported neonates.
Methods: This prospective observational study was carried out on 300 transported neonates by applying TOPS parameters within an hour of admission, and the outcome was assessed after 72 h of hospitalization.
Results: Hypothermia, hypoxemia, hypoperfusion, and hypoglycemia were found in 37%, 30%, 32%, and 13.33% of the neonates, respectively. The neonatal mortality rate was obtained at 20.67%. Among the non-survivors, hypoxemia was the most prevalent abnormality, followed by hypoperfusion in 77.42% of the neonates. All the neonates with all normal parameters (score 0) survived, while those with all abnormal parameters (score 4) showed 100% mortality. It was observed that an increase in the score led to an increase in the mortality rate, and it was statistically significant (P=0.001). The overall sensitivity and specificity were estimated at 87.1% and 84.03%, respectively, with a positive predictive value of 58.7% and a negative predictive value of 96.15%. The area under the receiver operating characteristic curve was 0.913 when the TOPS score was ≥ 2. The prediction of mortality was most sensitive with hypoxemia, followed by hypoperfusion, with sensitivities of 82.26% and 77.42% and negative predictive values of 94.76% and 93.14%, respectively.
Conclusion: The TOPS score was a reliable tool to predict mortality in transported neonates as mortality significantly increased by an increase in the TOPS score. Mortality was high when the scores of all four parameters were abnormal, while there was a better chance of survival with a score of zero.
 
 

Keywords

References

  1. Kapoor M, Kim R, Sahoo T, Roy A, Ravi S, Shiv Kumar AK, et al. Association of maternal history of neonatal death with subsequent neonatal death in India. JAMA Netw Open. 2020; 3(4):1-11.
  2. Newborns: improving survival and well-being. 2021. Available on http://www.who.int/news-room/factsheet/details/ newborns-reducing-mortality
  3. National Family Health Survey-5 2019-2021India Fact Sheet. 2021. Available on http://rchiips.org/ nfhs/factsheet_NFHS-5.shtml.
  4. Patel R, Marbaniang S, Srivastava S, Kumar P, Chauhan S. Why women choose to delivered at home in India: a study of prevalence, factors, and socio-economic inequality. BMC public Health. 2021; 21:1-14.
  5. Mondal T, Khatun M, Md Habibulla SK, Ray S, Hazra A, MD I, et al. Epidemiolgy of newborn transport in India- the reality check. Med J. 2021; 14(3):308-13.
  6. Punitha P, Kumaravel KS, Pugalendhiraja KV. A study on the current status of neonatal transport to a special newborn care unit. SMJ. 2016; 3(3):55-58
  7. Meshram RM, Jain DL, Apte MU, Denge A. Morbidity and mortality pattern of intramural and extramural neonate: a prospective observational study. Int J Contemp Pediatr. 2021; 8(6):1006-113.
  8. Cockburn F, Cooke RW, Gamsu HR, Greenough A, hopkins A, Mcintosh N, et al. The CRIB(clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensivr care units. Lancet. 1993; 24(342):193-8.
  9. Parry G, Tucker J, Tarnow-Mordi W. CRIB II: an update of the Clinical Risk Index for babies score. Lancet. 2003; 361(9371):1789-9.
  10. Richardson DK, Gray JE, McCormick MC, Workman K, Goldmann DA. Score for Neonatal Acute Physiology: a physiological severity index for neonatal intensive care. Pediatrics. 1993; 91(3):617-23.
  11. Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE- II: simplied newborn illness severity andmortality risk scores. J Pediatrics. 2001; 138(1):92-100.
  12. Gray JE, Richardson DK, McCormick MC, Workman-Daniels K, Goldmann DA. Neonatal Therapeutic Intervention Scoring system: a therapy based severity –of –illness index. Pediatrics. 1992; 90(4):561-7
  13. Mathura NB, Arora D. Role of TOPS ( a simplified assessment of neonatal acute physiology) in predicting mortality in transported neonates. Acta Pediatr. 2007; 96(2):172-5.
  14. Sen S, Datta I, Geddam N, Kumar A. Is there a correlation between the outcome of referred sick neonates and peripheral utilization of resources during transport? Evidence from the NICU of a tertiary care hospital of Eastern India using TOPS score. Int J Sci Res. 2020; 9(1):13-5.
  15. Baghel AK, Arora KK, Mulye S, Malhotra A. Analysis of the adverse events related to transfer of neonates to a tertiary center of Central India. Indian J Child Health. 2019; 6(10):559-62.
  16. Verma SK, Nagaura CP, Goyal VK, Raheja KK, Singh A, Sharma P, et al. Status of transported neonate and evaluation of TOPS as a survival score. Neonatal Med . 2017; 5(2):1-5.
  17. Asari US, Shah PA, Jagiwala GP, Patel RM, Kolcha BA, Patel PB. A study of correlation of TOPS score with outcome of referred neonates. Natl J Community Med. 2020; 11(5):211-215.
  18. Hapani PT, Berwal A, Dave H. Application of Tops score in sick neonates received at level 3 NICU and its impact on the outcome of the neonate. IOSR J Dent Med Sci. 2019; 18(3):11-5.
  19. Parekh ZR, Bharadwaj R, Parmar G, Shah A. Study of referral pattern of neonates at tertiary care centre and role of TOPS score in assessing morbidity and mortality. Natl J Community Med. 2018; 9(3):157-60.
  20. Shah DM, Bhuvaneswari M, Ramaprasad GS. Utility of transport risk index of physiological stability score for predicting likely outcome of extramural neonates transferred to NICU. Int J Contemp Pediatr. 2020; 7(5):1081-7.
  21. Sheth NM, Pandya N. Evaluation of TOPS score as predictor for outcome in sick newborns. Int J Contemp Pediatr. 2020; 7(6):1249-55.
  22. Pathak GH, Chauhan AV, Patel PB. Correlation of TOPS scoring with immediate outcome among neonates transported to special newborn care unit: a prospective study. Int J Contemp Pediatr. 2019; 6(6):2394-7.
  23. Begum A, Ashwani N, Kumar CS. TOPS: a reliable and simplified tool for predicting mortality in transported neonate. IOSR J Dent Med Sci. 2016; 15(2):53-8.
  24. Mehta N, Sharma MK. Correlation of acute physiological parameters with immediate outcome among neonates transported to special care newborn unit: A prospective study. Indian J Child Health. 2018; 5(4):280-3.
  25. Chheda A, Khadse S, Valvi C, Kulkarni R, Hiremath A. Importance of Temperature, Oxygen Saturation, Perfusion, Sugar (TOPS) Parameters and the concept of TOPS score for neonatal transport in India - A pilot Project. Pediatr Oncall J. 2018; 15(3):69-72.
  26. Dalal E, Vishal G, Solanki D. Study on neonatal transport at tertiary care centre. Int J Sci Res. 2013; 2(12):289-92.
Iranian Journal of Neonatology
Volume 13, Issue 3
July 2022
Pages 29-36

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