A Prospective Observational Study To Evaluate TOPS Score As An Outcome Predictor In Extramural Referred Neonates Admitted At A Tertiary Care Center

Background:The neonatal period is the most vulnerable time for a child's survival. As survival perspective of extramural neonates significantly relies on the state of neonate at admission, various survival scores like CRIB, SNAP, MINT, TRIPS, TOPS etc. are designed to prognosticate the outcome of neonate at admission. This study was de signed to delineate correlation of TOPS score with outcome of referred neonates.Aims And Objectives:To recognise correlation of TOPS score with outcomes of extramural neonates. Material And Methods:It was prospective observational study conducted from September 2019 to February 2020 at nicu of tertiary care hospital. Clinico-demographic characteristics and TOPS score were documented in a pre-designed proforma. Hypothermia, Hypoxia, prolonged CRT and Hypoglycemia were defined as<36.5C, <90%, ?3 secs and <40mg/dl respectively. Each parameter was assigned a score of ‘1’ if abnormal and ‘0’ if normal. Neonates were treated as per standard protocol and their outcome was recorded as survive d or expired. Result:Out of 239 neonates 140 (58.6%) were males and 99 (41.5%) were females. The area under the ROC curve (AUROC) for TOPS Total predicting Outcome: Expired vs Outcome: Survived was 0.932. At a cut-off of TOPS Total ?2, it predicts Outcome: Expired with a sensitivity of 83% and a specificity of*The relative risk (95% CI) for Outcome: Expired when TOPS Total is ?2 was 25.68.Hypothermia (Chi-squared test, ?2 = 38.462, p = <0.001), hypoxia (Fisher's exact test, ?2 = 122.636, p = <0.001), poorperfusion (shock) (Fisher's exact test, ?2 = 103.563, p = <0.001) are found to be significantly associated with poor outcome. Conclusion:TOPS score is an easy, reliable and applicable tool for outcome prediction of transported neonates.

Evaluation of TOPS score as predictor for outcome in sick newborns

Background: Multiple parameters have been developed to prognosticate the outcomes of critically ill newborns admitted in NICUs. The objective of this study is to predict the outcome of newborns admitted in NICU using a simple but efficient score, TOPS score, involving alteration of physiological parameters. Aim of this study was to evaluate role of TOPS score in predicting mortality in sick neonates.Methods: The variables assessed under TOPS score on arrival for all subjects were: Temperature, Oxygen Saturation, Perfusion and blood glucose reading <45 mg/dl. All affected neonates were given treatment as per NICU protocol and outcome was assessed in terms of mortality or discharge using TOPS score. It was prospective study conducted at NICU, Department of Pediatrics, GMERS medical college and general hospital, Gotri, Vadodara. Study population was all admitted neonates aged <28 days at NICU.Results: Mean age of presentation of all cases was 2.8'3.58 days. Hypothermia on admission was observed in 63.3% cases. 40.8% cases had hypoxia. 26.5% neonates recorded poor perfusion. Mortality observed in hypoxic group was 51.7% followed by hypothermic group (46.9%). Highest strength of association was found for poor perfusion, mortality (87.5%) and OR-33.406.' TOPS score was observed to be statistically significant (X2 value is 63.27, p < 0.05) as predictor of mortality. Thus, mortality rate increased with increasing no. of altered TOPS parameters. Regression analysis showed three factors (hypothermia, hypoxia, prolonged CRT) which are consistently associated with p value ? 0.05 for each variable and can be used to predict mortality.Conclusions: All parameters in TOPS score are physiologically important and each parameter carries an independent risk associated with mortality. It is important to note that multiple parameters affected increases the risk. TOPS score is a simple, basic and effective tool to guide about the condition of new born at admission and outcome. of neonatal mortality.

Correlation of TOPS scoring with immediate outcome among neonates transported to special newborn care unit: a prospective study

Background: Several sick neonates require transfer to tertiary level care neonatal unit for treatment. The facilities of neonatal transport in India are not optimal and the newborn thus transported can become hypothermic, hypoxic and/or hypoglycemic which can affect the neonatal outcome. These parameters can be maintained during transport by adopting simple measures. The aim and objective of this study is to study impact of acute physiological parameters during transfer of neonates on their immediate outcome by using TOPS score. TOPS score - Temperature, Oxygenation, Perfusion (Assessed by capillary refill time), Blood sugar.Methods: This prospective observational study was conducted at the special newborn care unit, Civil Hospital, Ahmedabad enrolling 460 transported neonates. TOPS scoring for each neonate was done at admission, and then the parameters of the TOPS score were correlated with the outcome at 48 h of admission.Results: A total of 460 transported newborns were assessed, 47.8% newborns were hypothermic, 33.9% had poor perfusion, 27.8% were hypoxemic, and 22% were hypoglycemic. On correlating with the outcome, Hypoxemia and hypo perfusion had the highest sensitivity (92.2% and 57.3%, respectively) while hypoglycemia had the highest specificity (88%), for an adverse outcome.Conclusions: TOPS score is a useful and easy to use the method to assess the physiological status and predict early mortality in transported neonates.