Introduction The Prince of Songkla University (PSU)-neonatal early warning score (PSU-NEWS) was developed to assist nurses in rapidly assessing the neonatal status and communicating clinical concerns. This study aimed to evaluate the accuracy of the PSU-NEWS in identifying neonates who required non-invasive ventilation (NIV) or admission to the neonatal intensive care unit (NICU). Methods This retrospective study included neonates admitted to a nursery between July 2023 and June 2024. All infants were born at ≥35 weeks’ gestation and birth weight ≥1,800 g and were categorized into those transferred to the NICU and those transferred to the postpartum ward. The first and second PSU-NEWS assessments were performed 1–2 h and 4–6 h after birth. Results The first and second PSU-NEWS were assessed in 2,191 and 1,908 neonates, respectively. Of these, 176 required NICU admission and 132 required NIV. In predicting NICU admission, the first PSU-NEWS demonstrated an overall AUC of 0.637 (95% CI: 0.593–0.681). At a cut-off score of ≥2, the receiver operating characteristic (ROC) analysis yielded an AUC of 0.628 with a sensitivity of 47% and specificity of 78%, whereas the second PSU-NEWS showed an overall AUC of 0.755 (95% CI: 0.717–0.792). At a cut-off score of ≥1, the ROC analysis yielded an AUC of 0.751 with a sensitivity of 60% and specificity of 90%. For predicting NIV requirement, the first PSU-NEWS demonstrated an overall AUC of 0.628 (95% CI: 0.575–0.682). At a cut-off score of ≥2, the ROC analysis yielded an AUC of 0.632 with a sensitivity of 48% and specificity of 78%, whereas the second PSU-NEWS showed an overall AUC of 0.785 (95% CI: 0.744–0.826). At a cut-off score of ≥1, the ROC analysis yielded an AUC of 0.783 with a sensitivity of 67% and specificity of 89%. Conclusions The PSU-NEWS demonstrated moderate accuracy in identifying neonates requiring NICU admission or NIV, and the second assessment provided a better predictive performance than the first. Serial scoring may enhance early recognition of infants requiring intensive care.
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