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Evaluation of Modified Extended Sick Neonate Score to Predict In-Hospital Mortality among Newborns Admitted to Resource-Poor Settings in Rural India

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Indian Journal of Pediatrics Aims and scope Submit manuscript



To devise a score based on eight extended sick neonatal score (ESNS) variables by adding two more variables, birth weight, and gestational age to check its efficacy.


A retrospective study was conducted on 521 neonates admitted from January 2018 to June 2020 in the neonatal intensive care unit (NICU) of a tertiary care center. The proposed score has the following components, respiratory effort, heart rate, axillary temperature, capillary refill time, random blood sugar, pulse oximeter saturation, Moro reflex, modified Downes score, gestation age, and birth weight. Each was scored as 0, 1, and 2. The total score for each neonate was calculated from the records available and outcome documented. Receiver operating characteristic (ROC) curve was generated; and a cutoff score was derived to predict mortality and compared with modified sick neonatal score (MSNS).


Modified ESNS has a strong correlation with the outcome. Area under the ROC curve was 0.995 (95% CI: 0.925–0.985) for modified ESNS and 0.933 (95% CI: 0.901–0.976) for MSNS. The optimum cutoff values for predicting mortality were 15.5 for modified ESNS and 12.5 for MSNS. For a cutoff score of ≤ 15, sensitivity and specificity were 86.27% and 86.60% for modified ESNS and 90.20% and 84.89%, respectively, for MSNS, in predicting mortality. Positive and negative predictive values were 41.12% and 98.31% for modified ESNS and 39.32% and 98.76%, respectively for MSNS.


The modified ESNS can predict in-hospital mortality among neonates, with good sensitivity and specificity.

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Authors and Affiliations



NSB conceptualized the study and played primary role in compiling, analysis and interpretation of the data; AJ, BC, and VBK prepared and reviewed all the drafts and approved the final draft; BC, VBK, NSB contributed in fine-tuning of the proposal, and in data collection and entry; AJ, BC, VBK, NSB reviewed the results and contributed to the preparation and review of drafts; All the authors have read and approved the final version of the manuscript. All the authors take complete responsibility for the content of the manuscript. NSB will act as the guarantor for this paper.

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Correspondence to N. Shivaramakrishna Babji.

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This study was approved by the Research Ethics Committee and was carried out following the principles contained within the 1964 Declaration of Helsinki and as revised in 2013.

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Jayasheel, A., Chandrasegaran, B., Kumar, V.B. et al. Evaluation of Modified Extended Sick Neonate Score to Predict In-Hospital Mortality among Newborns Admitted to Resource-Poor Settings in Rural India. Indian J Pediatr 90, 341–347 (2023).

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