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

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 ۳۰۰ transported neonates by applying TOPS parameters within an hour of admission, and the outcome was assessed after ۷۲ h of hospitalization. Results: Hypothermia, hypoxemia, hypoperfusion, and hypoglycemia were found in ۳۷%, ۳۰%, ۳۲%, and ۱۳.۳۳% of the neonates, respectively. The neonatal mortality rate was obtained at ۲۰.۶۷%. Among the non-survivors, hypoxemia was the most prevalent abnormality, followed by hypoperfusion in ۷۷.۴۲% of the neonates. All the neonates with all normal parameters (score ۰) survived, while those with all abnormal parameters (score ۴) showed ۱۰۰% mortality. It was observed that an increase in the score led to an increase in the mortality rate, and it was statistically significant (P=۰.۰۰۱). The overall sensitivity and specificity were estimated at ۸۷.۱% and ۸۴.۰۳%, respectively, with a positive predictive value of ۵۸.۷% and a negative predictive value of ۹۶.۱۵%. The area under the receiver operating characteristic curve was ۰.۹۱۳ when the TOPS score was ≥ ۲. The prediction of mortality was most sensitive with hypoxemia, followed by hypoperfusion, with sensitivities of ۸۲.۲۶% and ۷۷.۴۲% and negative predictive values of ۹۴.۷۶% and ۹۳.۱۴%, 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:

Neonatal transport , Oxygenation , Perfusion , Sugar , Temperature , TOPS score