A Prospective Observational Study to Evaluate Tops Score as an Outcome Predictor inExtramural Referred Neonates Admitted at a Tertiary Care Hospital, Jhalawar Medical College

Abstract

 Introduction: Neonatal mortality remains a significant global health concern, particularly in low-resource settings where inadequate transport and stabilization lead to adverse outcomes. The TOPS (Temperature, Oxygen Saturation, Perfusion, Sugar) score is a simple and rapid bedside assessment tool that can help predict neonatal outcomes upon admission. This study evaluates the prognostic value of the TOPS score in predicting mortality and morbidity among extramural neonates referred to a tertiary care hospital. Aim : This study aims to assess the TOPS score's prognostic value in predicting mortality and morbidity in extramural neonates and evaluate the impact of transport conditions and pre-transport stabilization on outcomes. Materials and Methods: Aprospective observational study was conducted in the NICU of Shrimati Heera Kunwar Baa Maheela Hospital, Jhalawar, over one year. A total of 402 referred neonates were included, and their TOPS scores were recorded at admission. The association between transport conditions, stabilization status, neonatal characteristics, and clinical outcomes was analyzed using SPSS version 21.0, with p<0.05 considered statistically significant. Results: Of the 402 neonates, 75.1% survived, while 24.9% died. Mortality was significantly higher in neonates with low birth weight, prolonged transport duration, lack of pre-transport stabilization, and severe respiratory distress. The mean TOPS score was lower among non-survivors (1.53 ± 1.05) compared to survivors (2.51 ± 0.86) (p = 0.0001). Abnormal TOPS parameters hypothermia, hypoxia, poor perfusion, and hypoglycemia were strongly associated with increased mortality. Conclusion: The TOPS score is an effective, low-cost predictor of neonatal mortality in resource-limited settings. Routine assessment of TOPS parameters during neonatal transport can aid in early risk stratification and improve stabilization efforts, potentially reducing neonatal deaths. Future studies are warranted to validate its applicability across different healthcare settings.