title: Development and validation of the Neonatal Mortality Score-9 Mexico to predict mortality in critically ill neonates.
abstract: Prognostic scales or scores are useful for physicians who work in neonatal intensive care units. There are several validated neonatal scores but they are mostly applicable to low birth weight infants. The aim of this study was to develop and validate a mortality prognostic score in newborn infants, that would include new prognostic outcome measures.
  
  
  
  The study was conducted in a mother and child hospital in the city of Mexico, part of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security). In the first phase of the study, a nested case-control study was designed (newborn infants admitted on the basis of severity criteria during the first day of life), in which a scale was identified and developed with gradual parameters of cumulative score consisting of nine independent outcome measures to predict death, as follows: weight, metabolic acidemia, lactate, PaO2/FiO2, p(A-a) O2, A/a, platelets and serum glucose.Validation was performed in a matched prospective cohort, using 7-day mortality as an endpoint.
  
  
  
  The initial cohort consisted of 424 newborn infants. Twenty-two cases and 132 controls were selected; and 9 outcome measures were identified, making up the scale named neonatal mortality score-9 Mexico. The validation cohort consisted of 227 newborn infants. Forty-four (19%) deaths were recorded, with an area under the curve (AUC) of 0.92. With a score between 16 and 18, an 85 (11-102) hazard ratio, 99% specificity, 71% positive predictive value and 90% negative predictive value were reported. Conclusions .The proposed scale is a reliable tool to predict severity in newborn infants.
authors.affiliation: Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Cardiología.
authors.forename: Horacio
authors.initials: H
authors.lastname: Márquez-González
authors.affiliation: Coordinación de Investigación, Cancún.
authors.forename: María Valeria
authors.initials: MV
authors.lastname: Jiménez-Báez
authors.affiliation: Instituto Nacional de Pediatría.
authors.forename: C Mireya
authors.initials: CM
authors.lastname: Muñoz-Ramírez
authors.affiliation: Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Cardiología.
authors.forename: Lucelli
authors.initials: L
authors.lastname: Yáñez-Gutiérrez
authors.affiliation: Hospital de Ginecología y Obstetricia.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Huelgas-Plaza
authors.affiliation: Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Almeida-Gutiérrez
authors.affiliation: Facultad de Medicina, Facultad de Medicina, Universidad Nacional Autónoma de México.
authors.forename: Antonio Rafael
authors.initials: AR
authors.lastname: Villa-Romero
mesh_terms: D016022:Case-Control Studies; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008800:Mexico / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies