Mahmoud SM, Mohamed MM, Abdelfatah RZE, Abdelkreem E. Comparison of six neonatal mortality prediction scores: A prospective observational study. World J Clin Pediatr 2026; 15(4): 117203 [DOI: 10.5409/wjcp.117203]
Corresponding Author of This Article
Elsayed Abdelkreem, MD, PhD, Associate Professor, Consultant, DHPE, Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag University Street, Nasser City 82524, Sohag, Egypt. d.elsayedmohammed@med.sohag.edu.eg
Research Domain of This Article
Pediatrics
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research-article
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Mahmoud SM, Mohamed MM, Abdelfatah RZE, Abdelkreem E. Comparison of six neonatal mortality prediction scores: A prospective observational study. World J Clin Pediatr 2026; 15(4): 117203 [DOI: 10.5409/wjcp.117203]
Shaimaa Mohamed Mahmoud, Montaser Mohamed Mohamed, Rehab Zein Elabdeen Abdelfatah, Elsayed Abdelkreem, Department of Pediatrics, Faculty of Medicine, Sohag University, Nasser City 82524, Sohag, Egypt
Elsayed Abdelkreem, Department of Clinical Sciences, Al-Rayan National College of Medicine, Al-Rayan National Colleges, Al Madinah Al Munawwarah 41411, Saudi Arabia
Author contributions: Mahmoud SM, Mohamed MM, and Abdelfatah RZE contributed to edit the manuscript; Mahmoud SM, Mohamed MM, Abdelfatah RZE, and Abdelkreem E contributed to methodology; Mahmoud SM, Abdelfatah RZE, and Abdelkreem E contributed to data analysis and interpretation; Mohamed MM and Abdelkreem E shared in study design; Abdelfatah RZE contributed to investigation; Abdelkreem E wrote the manuscript draft. All authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Research Ethics Committee of Faculty of Medicine, Sohag University (approval No. Soh-Med-23-03-10MS; dated March 08, 2023).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Elsayed Abdelkreem, MD, PhD, Associate Professor, Consultant, DHPE, Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag University Street, Nasser City 82524, Sohag, Egypt. d.elsayedmohammed@med.sohag.edu.eg
Received: December 1, 2025 Revised: December 27, 2025 Accepted: March 13, 2026 Published online: December 9, 2026 Processing time: 295 Days and 3.6 Hours
Abstract
BACKGROUND
Various scoring systems have been developed for early identification of seriously ill neonates in the neonatal intensive care unit, but studies comparing their predictive accuracies are scarce.
AIM
To compare the performance of six neonatal mortality prediction scores in a resource-limited setting.
METHODS
This prospective observational study included neonates admitted within 24 hours of birth to a major Egyptian neonatal intensive care unit from March 2023 to May 2024. Each newborn was assessed within 12 hours after admission for Clinical Risk Index for Babies II (CRIB II), Score for Neonatal Acute Physiology II, Score for Neonatal Acute Physiology Perinatal Extension II, sensorium, temperature, oxygenation, perfusion, skin color, and blood sugar (STOPS), Modified Sick Neonatal Score (MSNS), and neonatal sequential organ failure assessment (nSOFA). Area under the receiver operating characteristic curve (AUC) was calculated for each score to assess and compare their predictive accuracy for all-cause in-hospital mortality.
RESULTS
A total of 299 neonates were included. Compared with survivors (n = 194), nonsurvivors (n = 105) exhibited significantly lower MSNS and higher other scores. The AUCs values were MSNS (0.91) > Score for Neonatal Acute Physiology Perinatal Extension II and STOPS (each 0.89) > neonatal sequential organ failure assessment and Score for Neonatal Acute Physiology II (each 0.88) > CRIB II (0.82). Overall predictive accuracy ranged from 87.3% for both MSNS (cutoff < 10) and STOPS (cutoff > 2) to 75.3% for CRIB II (cutoff > 4). All AUCs were comparable, except for CRIB II, which performed better in preterm babies < 33 weeks than in the overall cohort.
CONCLUSION
This study demonstrated good and comparable performance of multiple neonatal mortality prediction scores in a resource-limited setting, with more simple scores such as MSNS and STOPS offering the advantages of greater applicability.
Core Tip: This study provides the first head-to-head comparison of six neonatal mortality prediction scores applied within the same neonatal intensive care unit population in a resource-limited, high-mortality setting. All models demonstrated good-to-excellent discriminatory performance. Importantly, simple bedside scores, such as the Modified Sick Neonatal Score and sensorium, temperature, oxygenation, perfusion, skin color, and blood sugar score performed comparably to more complex physiology-based tools. These findings highlight the value of feasible, rapid, and non-invasive scoring systems for early risk stratification and clinical decision-making in neonatal intensive care units in low- and middle-income settings.
