Newborn early warning score as an observational tool to assess the outcome of newborns: A prospective observational study

Objectives: Early identification of physiological instability in neonates is critical to reduce morbidity and mortality, particularly in tertiary care settings. The newborn early warning score (NEWS) is a structured tool designed to detect neonatal instability by quantifying deviations in vital parameters. This study evaluates the effectiveness of NEWS in predicting neonatal intensive care unit (NICU) admission among neonates. Material and Methods: A prospective observational study was conducted over 18 months at two tertiary hospitals in Karnataka, India. 600 neonates were assessed using NEWS parameters – axillary temperature, respiratory rate and pattern, oxygen saturation (SpO2), pulse rate and neurological status – at birth, 5, 10, 30 min and 2 h post-birth. Statistical analyses included descriptive statistics, Chi-square, t -tests, Pearson’s correlation, receiver operating characteristic (ROC) curve analysis and binary logistic regression. Results: Among 600 neonates, 8.83% required NICU admission. NICU-admitted neonates had significantly higher respiratory pattern, pulse rate, SpO2 and total NEWS scores compared to discharged neonates ( p < 0.01). The total NEWS score showed a weak but significant positive correlation with NICU admission ( r = 0.237, p < 0.05). ROC analysis identified an optimal NEWS cutoff of 16.5 for predicting NICU admission with 69.8% sensitivity and 65.4% specificity (area under the curve [AUC] = 0.730). Logistic regression revealed respiratory score, pulse score and SpO2 score as independent significant predictors of NICU admission, with SpO2 being the strongest predictor (Odds Ratio = 2.78). NEWS effectively identifies neonates at risk of early physiological instability, particularly through cardiorespiratory parameters. Its moderate predictive accuracy supports its use as a complementary tool alongside clinical judgement. Limitations include predominance of term neonates and short monitoring duration. Conclusion: NEWS is a feasible, non-invasive tool for early detection of neonatal instability and risk stratification in tertiary care settings. Respiratory pattern, pulse rate and SpO2 are key predictors of NICU admission. Further studies are needed to validate NEWS across diverse neonatal populations and extended monitoring periods.