Comparative prognostic performance of the neonatal sequential organ failure assessment and score for neonatal acute physiology with perinatal extension-II score for predicting in-hospital mortality among neonates with sepsis: a retrospective cohort study

Background: Accurate risk stratification is essential for identification of neonates with sepsis at high risk of mortality. The neonatal sequential organ failure assessment (nSOFA) score reflects dynamic organ dysfunction, whereas the score for neonatal acute physiology with perinatal extension-II (SNAPPE-II) assesses baseline illness severity at admission. Methods: This retrospective cohort study included neonates with clinical sepsis admitted to a tertiary neonatal intensive care unit between September 2024 and March 2025. SNAPPE-II scores were calculated using admission data within the first 12 hours of NICU stay. nSOFA scores were calculated using the worst physiological parameters within 24 hours of sepsis diagnosis. The primary outcome was in-hospital mortality. Discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis, correlation analysis, and binary logistic regression. Results: Among 175 neonates, 35 (20.0%) died during hospitalization. Mean nSOFA and SNAPPE-II scores were higher among the non-survivors than survivors (nSOFA: 5.7±2.1 vs 2.3±1.9; SNAPPE-II: 56.4±19.8 vs 31.7±17.3; both p<0.001). The area under the ROC curve was 0.754 for nSOFA and 0.877 for SNAPPE-II. On logistic regression analysis, higher values of both scores were independently associated with increased odds of mortality. Conclusions: Both nSOFA and SNAPPE-II are effective predictors of in-hospital mortality in neonates with sepsis. SNAPPE-II demonstrated higher discriminative accuracy while nSOFA provides a dynamic insight of organ dysfunction. The complementary use of these scoring systems may enhance early risk stratification in neonatal intensive care units, particularly in resource-limited settings.