Comparing neonatal intensive care unit outcomes of intramural and extramural neonates using the modified sick neonate score


  • Kritika Naithani Department of Pediatrics, GMERS Medical College, Gotri, Vadodara, Gujarat, India
  • Sharanya Tripathi Department of Pediatrics, GMERS Medical College, Gotri, Vadodara, Gujarat, India
  • Hirva Trivedi Children’s Hospital of Philadelphia, Philadelphia, PA, USA
  • Nimisha K. Pandya Department of Pediatrics, GMERS Medical College, Gotri, Vadodara, Gujarat, India



MSNS, Sick neonate score, Neonatal mortality scoring, Outcomes, Intramural, Extramural


Background: India contributes to one-fifth of the world’s annual childbirths and one-fourth of the neonatal mortality burden, with rural areas having higher mortality rates. Several scoring systems have been used to independently predict neonatal outcomes in babies born elsewhere and transported to a facility (extramural) and in the inborn or intramural neonates. We used the modified sick neonate score (MSNS) to compare the outcomes in extramural and intramural neonates. The score considers eight parameters and quantitatively measures the neonates’ status. This study aimed to determine whether the MSNS effectively predicts mortality among the two study groups.

Methods: 410 neonates were considered for this prospective analytical study conducted at GMERS Hospital, Vadodara, a tertiary care center- over a duration of 20 months. Neonates were followed during their NICU stay, and outcomes were correlated with their scores recorded on admission.

Results: The intramural newborns had higher MSNS than the extramural neonates (13 and 12, respectively), with the difference statistically significant. At an optimal cut-off of <11, MSNS has a sensitivity of 85.11% and a specificity of 75.76% in predicting neonatal outcomes. The AUC was 0.859 (95% CI:0.822 to 0.891) with a positive predictive value of 31.2%, a negative predictive value of 97.5%, and an accuracy of 76.83%.

Conclusions: The MSNS effectively predicts mortality among intramural and extramural neonates, with the range being higher for inborn babies- indicating a better prognosis.


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Original Research Articles