Rationale: Use of severity of illness scores to classify patients for clinical care and research is common outside of the neonatal ICU. Extremely premature (<29 weeks' gestation) infants with extremely low birth weight (<1,000 g) experience significant mortality and develop severe pathology during the protracted birth hospitalization. Objectives: To measure at high resolution the changes in organ dysfunction that occur from birth to death or discharge home by gestational age and time, and among extremely preterm infants with and without clinically meaningful outcomes using the neonatal sequential organ failure assessment score. Methods: A single-center, retrospective, observational cohort study of inborn, extremely preterm infants with extremely low birth weight admitted between January 2012 and January 2020. Neonatal sequential organ failure assessment scores were calculated every hour for every patient from admission until death or discharge. Measurements and Main Results: Longitudinal, granular scores from 436 infants demonstrated early and sustained discrimination of those who died versus those who survived to discharge. The discrimination for mortality by the maximum score was excellent (area under curve, 0.91; 95% confidence intervals, 0.88-0.94). Among survivors with and without adverse outcomes, most score variation occurred at the patient level. The weekly average score over the first 28 days was associated with the sum of adverse outcomes at discharge. Conclusions: The neonatal sequential organ failure assessment score discriminates between survival and nonsurvival on the first day of life. The major contributor to score variation occurred at the patient level. There was a direct association between scores and major adverse outcomes, including death.

中文翻译：

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极早产儿关键器官功能障碍的每小时动力学。

理由：使用疾病严重程度评分对患者进行临床护理和研究分类在新生儿 ICU 之外很常见。出生体重极低 (<1,000 g) 的极早产儿（<29 周妊娠）在长期住院期间会出现严重的死亡率和严重的病理变化。目标：使用新生儿序贯器官衰竭评估评分，以高分辨率测量从出生到死亡或出院回家时按胎龄和时间发生的器官功能障碍的变化，以及极早产儿有和没有临床意义的结果。方法：一项单中心、回顾性、观察性队列研究，研究对象为 2012 年 1 月至 2020 年 1 月期间入院的出生体重极低的先天极早产儿。从入院到死亡或出院，每小时计算每位患者的新生儿序贯器官衰竭评估评分。测量和主要结果：来自 436 名婴儿的纵向、精细评分表明，对死亡者与存活出院者的早期和持续歧视。通过最大分数区分死亡率非常好（曲线下面积，0.91；95% 置信区间，0.88-0.94）。在有和没有不良后果的幸存者中，大多数评分变化发生在患者层面。前 28 天的每周平均得分与出院时不良结局的总和相关。结论：新生儿序贯器官衰竭评估评分可区分出生后第一天的存活和死亡。评分变化的主要贡献者发生在患者层面。分数与主要不良后果（包括死亡）之间存在直接关联。