NTISS Score (Neonatal Therapeutic Intervention Scoring System)
Evaluates severity of illness for neonatal therapeutic intervention.
Refer to the text below the calculator for more information.
The NTISS (Neonatal Therapeutic Intervention Scoring System) is a severity of illness index assessment for use in neonatology, a score that has proven valuable in assessing clinical outcomes and resource consumption in neonatal intensive care.
The NTISS score was created by modifying the Therapeutic Intervention Scoring System (TISS).
42 items were deleted from the 76 original items of the TISS and 28 new items were added. Each item assigns scores from 0 to 4 for various intensive care therapies (some of which are grouped).
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About the NTISS
The NTISS (Neonatal Therapeutic Intervention Scoring System) measures severity of illness by quantifying the intensity and complexity of care received and is a score that has proven valuable in assessing clinical outcomes and resource consumption in neonatal intensive care.
The National Therapeutic Intervention Scoring System (NTISS) was created by modifying the Therapeutic Intervention Scoring System (TISS).
42 items were deleted from the 76 original items of the TISS and 28 new items were added. Each item assigns scores from 0 to 4 for various intensive care therapies (some of which are grouped).
| Item | Points |
| Respiratory | |
| Supplemental oxygen a | 1 |
| CPAP a | 2 |
| Mechanical ventilation a | 3 |
| Mechanical ventilation with muscle relaxation a | 4 |
| High-frequency ventilation a | 4 |
| Surfactant administration | 1 |
| Endotracheal intubation | 2 |
| Tracheostomy care b | 1 |
| Tracheostomy placement b | 1 |
| Extracorporeal membrane oxygenation | 4 |
| Monitoring | |
| Frequent vital signs | 1 |
| Phlebotomy (5-10 blood draws) c | 1 |
| Phlebotomy (>10 blood draws) c | 2 |
| Cardiorespiratory monitoring | 1 |
| Thermoregulated environment | 1 |
| Non-invasive oxygen monitoring | 1 |
| Arterial pressure monitoring | 1 |
| Central venous pressure monitoring | 1 |
| Urinary catheter | 1 |
| Quantitative intake and output | 1 |
| Cardiovascular | |
| Indomethacin administration | 1 |
| Volume expansion (≤15 mL/kg) d | 1 |
| Volume expansion (>15 mL/kg) d | 3 |
| Vasopressor administration (1 agent) e | 2 |
| Vasopressor administration (>1 agent) e | 3 |
| Cardiopulmonary resuscitation | 4 |
| Pacemaker on standby f | 3 |
| Pacemaker used f | 4 |
| Vascular access | |
| Peripheral intravenous line | 1 |
| Arterial line | 2 |
| Central venous line | 2 |
| Metabolic/Nutrition | |
| Gavage feeding | 1 |
| Phototherapy | 1 |
| Intravenous fat emulsion | 1 |
| Intravenous amino acid solution | 1 |
| Insulin administration | 2 |
| Potassium infusion | 3 |
| Transfusions | |
| Intravenous gamma globulin | 1 |
| Double volume exchange transfusion | 3 |
| Partial volume exchange transfusion | 2 |
| Red blood cell transfusion (≤15 ml/kg) g | 2 |
| Red blood cell transfusion (>15 ml/kg) g | 3 |
| Platelet transfusion | 3 |
| White blood cell transfusion | 3 |
| Procedures | |
| Transport of patient | 2 |
| Dialysis | 4 |
| Single chest tube in place h | 2 |
| Multiple chest tubes in place h | 3 |
| Thoracentesis | 3 |
| Pericardial tube in place i | 4 |
| Pericardiocentesis i | 4 |
| Minor operation j | 2 |
| Major operation j | 4 |
| Drug therapy | |
| Antibiotic administration (≤2 agents) k | 1 |
| Antibiotic administration (>2 agents) k | 2 |
| Enteral diuretic administration l | 1 |
| Parenteral diuretic administration l | 2 |
| Anticonvulsant therapy | 1 |
| Aminophylinne administration | 1 |
| Other unscheduled medication | 1 |
| Steroid administration (postnatal) | 1 |
| Potassium binding resin administration | 3 |
| Treatment of metabolic acidosis | 3 |
* Items with letters in parenthesis represent the variables between which only the highest scores are computed.
Instructions for administering NTISS
NTISS scores compute the most intense level for each therapy during a 24-hour period. The first scoring period usually begins on admission. It is also important to delineate during subsequent administrations of the score whether scores are based on initiation of therapy or continuation.
In the final calculations of scores for NTISS, points should be assigned only for the most intense intervention in a group of therapies.
For example, in the case of a new-born started on supplemental oxygen (during first scoring period), who was then placed on CPAP, then on mechanical ventilation. In the final score, the patient would receive points for mechanical ventilation because it is the most intense respiratory therapy received.
About the original study
In the original study by Gray et al. admission-day NTISS scores were calculated for 1643 new-borns admitted to three neonatal intensive care units (NICUs). NTISS scores ranged from 0 to 47 with a mean of 12.3 +/- 8.7 (SD).
The NTISS scores were found to have little correlation with birth weight (r = -.11) or gestational age (r = -.17) but were highly correlated with expected markers of illness severity, including mortality risk estimates by neonatal attending physicians (r = .70, P < .0001), in-hospital mortality rates (P < .05).
NTISS scores were also found to be predictive of:
- NICU length of stay (r = .37, P < .0001);
- Total hospital charges for survivors (r = .65, P < .0001).
References
Original reference
Gray JE, Richardson DK, McCormick MC, Workman-Daniels K, Goldmann DA. Neonatal Therapeutic Intervention Scoring System: A Therapy-Based Severity-Of-Illness Index. Pediatrics. 1992; 90(4):561-7.
Other references
Wua PL, Leeb WT, Leeb PL, Chen HL. Predictive Power of Serial NeonatalTherapeutic Intervention Scoring System Scores for Short-term Mortality inVery-low-birth-weight Infants. Pediatrics and Neonatology (2015)56, 108-113.
Richardson DK, Gray JE, McCormick MC, Workman K, Goldmann DA. Score for Neonatal Acute Physiology: a physiologic severity index for neonatal intensive care. Pediatrics. 1993; 91(3):617-23.
Garg B, Sharma D, Farahbakhsh N. Assessment of sickness severity of illness in neonates: review of various neonatal illness scoring systems. J Matern Fetal Neonatal Med. 2018; 31(10):1373-1380.
Specialty: Neonatology
Year Of Study: 1992
Abbreviation: NTISS
Article By: Denise Nedea
Published On: May 28, 2020 · 12:00 AM
Last Checked: May 28, 2020
Next Review: May 28, 2025