Development and Validation of the SINCRS: A Novel South Indian Neonatal Cardiovascular Risk Score Using Enhanced Cord Blood Lipid Profiling

Abstract

Background: Traditional cord blood lipid profiles provide limited cardiovascular risk stratification in neonates. India faces a high burden of preterm births and low birth weight deliveries, yet lacks population-specific neonatal cardiovascular screening tools. This study aimed to develop a novel risk scoring system using enhanced lipid ratios and establish population-specific reference values for South Indian neonates.

Methods: In this observational cross-sectional study, 150 neonates born between 28-42 weeks gestation at a tertiary hospital in South India were enrolled. Umbilical cord blood was analyzed for traditional lipid parameters and novel ratios including triglyceride/high-density lipoprotein (TG/HDL), non-HDL cholesterol, and low-density lipoprotein/HDL (LDL/HDL) ratios. The South Indian Neonatal Cardiovascular Risk Score (SINCRS) was developed using multiparameter receiver operating characteristic (ROC) analysis and validated against gestational age and birth weight outcomes.

Results: Novel finding: TG/HDL ratio demonstrated exceptional discriminatory power with 88.3% increase in preterm versus term neonates (3.27 ± 0.41 vs 1.74 ± 0.28, p<0.001, Cohen's d=3.85). Non-HDL cholesterol showed 81.5% increase in preterm neonates (69.5 ± 6.8 vs 38.3 ± 4.2 mg/dL, p<0.001, d=5.12). The SINCRS achieved superior diagnostic accuracy (AUC=0.941, 95% CI: 0.908-0.974) with 93% sensitivity and 88% specificity for identifying high-risk neonates. All novel ratios exhibited very large effect sizes (d>3.0), indicating exceptional clinical significance. Population-specific percentiles were established for the first time in South Indian neonates.

Conclusion: This study introduces the first validated neonatal cardiovascular risk scoring system with superior diagnostic performance for South Asian populations. The TG/HDL ratio emerges as a novel biomarker with immediate clinical applicability, while SINCRS provides a practical tool for risk stratification that could transform neonatal care protocols.