Validation of Post-transport Temperature–Oxygenation–Perfusion–Sugar Score in Predicting Mortality of Outborn Neonates Admitted to a Level III NICU in Western India: A Prospective Observational Study

Abstract

Aim

To validate the role of the Temperature–Oxygenation–Perfusion–Sugar (TOPS) score, especially post-transport TOPS, as a simple bedside prognostic tool for predicting mortality among outborn neonates admitted to a tertiary neonatal intensive care unit (NICU).

Methods

A prospective observational study was conducted at a level III NICU in Western India over 12 months. Outborn neonates transported from peripheral centers were enrolled. At admission, physiological parameters (temperature, oxygenation, perfusion, blood glucose) were recorded to calculate the TOPS score. The primary outcome was in-hospital mortality. Secondary outcomes included NICU stay, requirement for inotropes, and mechanical ventilation. Statistical tests included Chi-square/Fisher’s exact test and univariate odds ratios.

Results

Of 267 admitted neonates, 186 met inclusion criteria (54% male, mean birth weight 2.25 ± 0.65 kg, mean admission age 4.8 ± 1.96 days). Hypothermia was present in 40.8%, hypoxia in 33.8%, poor perfusion in 18.8%, and hypoglycemia in 13.9%. Mortality was 18% (33 neonates). Poor perfusion showed the strongest association with mortality (odds ratio: 11.6, 95% CI: 4.3-28.7). Mortality increased with higher TOPS scores (P value <.05). Neonates with a score of 4/4 had a mean NICU stay of 16.5 days compared to 5.7 days for score 0, and required significantly more ventilatory and inotropic support.

Conclusion

The TOPS score is a simple, rapid, and effective triage tool significantly associated with neonatal mortality and morbidity. It may be especially valuable in resource-limited settings for early risk stratification of transported neonates. However, independent predictive validity against established scores (SNAPPE-II, CRIB) requires further study.