Anuradha Bansal

Suksham Jain

Directory of Open Access Journals

Dicle Tıp Derg/Dicle Med J Copyright © Dicle Tıp Dergisi 2009  Cilt/Vol 36, No 4, 333-335 Tarihi / Received: 12.08.2009, Kabul Tarihi / Accepted: 25.10.2009 Yazışma Adresi /Correspondence: Dr. Suksham Jain, Assist. Prof. Pediatrics, Government Medical College & Hospital, Chandigarh, India Email: dr.sukshamj@gmail.com LETTER TO EDITOR / EDİTÖRE MEKTUP SNAPPE II score for predicting mortality in a level II neonatal intensive care unit İkinci basamak yenidoğan yoğun bakım ünitesinde mortaliteyi öngörmede SNAPPE II skorlaması Suksham Jain, Anuradha Bansal Government Medical College and Hospital, Department of Pediatrics, Chandigarh, India  Dear Editor, Severity  of  illness in neonates  and  mortality has various scoring system, which have been vali-dated in different neonatal set-ups. The Score for Neonatal  Acute  Physiology  (SNAP)  was  devel-oped in 1993 for babies of all birth weights and va-lidated as a predictor of mortality1. It is a physiol-ogy-based score that uses 34 routinely available vi-tal signs and laboratory test results. It’s perinatal extension, Score of Neonatal Acute Physiology Pe-rinatal Extension (SNAPPE) was validated in US set up2. The Clinical Risk for Babies score (CRIB) was developed for babies <1500 g, consists of 3 physiologic variables plus birth weight, gestational age, and congenital anomalies3. CRIB-II is calcu-lated from five items: sex, birth weight, gestation age, worst base excess and temperature at admis-sion4. SNAP was cumbersome to use because of the number and complexity of items1. The Score for Neonatal Acute Physiology Pe-rinatal Extension, SNAPPE-II is a scoring system developed  and  validated  by  Richardson  et  al  in 2001 for illness severity and mortality risk scores for newborn intensive care5. It is simple, accurate and  robust  across  populations.  This  system  in-cludes 9 physiological and laboratory evaluations regarding the vital functions collected during the first  12  h  after  delivery.  The  SNAPPE-II  values range from 0 to 162 and are proportional to the ill-ness severity, with higher scores indicating higher mortality or morbidity risks. The SNAPPE-II can be used in patients with all birth weight and gesta-tion age5. CRIB, SNAP, CRIB II and SNAPPE-II score has  been  validated6-9,  CRIB  II  and  SNAP  II  has been validated in Indian set up also10,11. But there is no study on validation of SNAPPE II in neonatal intensive care unit in Indian setup. We collected data prospectively on all sequen-tial  inborn  admissions  to  our  neonatal  intensive care unit, of all birth weights over 10 weeks after excluding: babies transferred out to the step down care area in <24 hours, babies admitted to the neo-natal intensive care unit at >48 hours of age or af-ter having been discharged home, moribund infants when an explicit physician decision not to provide life support was made at the time of neonatal in-tensive care unit admission and babies who left the unit against medical advice. SNAPPE-II was cal-culated from nine items: birth weight; being small for gestation age (SGA); APGAR at five minutes; urine  output;  lowest  mean  blood  pressure;  worst PaO2/FIO2  ratio;  lowest  pH;  occurrence  of  sei-zures; lowest temperature. Although antenatal ster-oid prophylaxis, caesarean section, and not having any congenital anomaly are tended to be of signifi-cance  with  a  better  survival  in  very  low  birth weight were not included for analysis. The data  collection window was the first 12 hours after admission to the NICU. A total of 66 babies  were  admitted  in  neonatal  intensive  care unit, NICU during this period and 63 met the in-clusion  criteria.  Mean  birth  weight  was  1382.7± 581.3  grams  and  gestation  age  was  31.1±2.9 weeks. Mortality rate was 11.1%. As the score in-creased to 40 and above chances of mortality in-creased and it was maximum with score of 80 and         -               -               -               -               -       S. Jain, A. Bansal Dicle Tıp Derg / Dicle Med J Cilt/Vol 36, No 4, 333-335 334 above. Mean score in those who survived and in neonates  with  mortality  was  calculated  for  each group. Data are shown in Table 1.  Table I. SNAPPE II scores in infants those who survived or died. SNAPPE II score No. of babies n=63 Died  n=7 (11.1%) Mean (SD) score/survived Mean score (SD)/died 0-9  14  0  2.1 (2.6)  - 10-19  7  0  15.1 (2.9)  - 20-29  17  1 (5.8%)  24.6 (2.5)  24 30-39  15  1 (6.6%)  33.9 (2.8)  37 40-49  8  3 (37.5%)  44.3 (3.6)  47 (2) 50-59  0  0  -  - 60-69  0  0  -  - 70-79  0  0  -  - ≥ 80  2  2 (100%)  -  94 (1) SD: standard deviation  Score  of  illness  severity  varies  according  to birth weight, gestation age and as per the level of care  inform  of  antenatal  corticosteroids  use  and surfactant use5. CRIB (clinical risk index for ba-bies) and SNAPPE (score for neonatal acute phy-siology-perinatal  extension)  are  the  most  com-monly used scores, and their performance has been extensively validated. However, both scores have some limitations and were developed almost a dec-ade ago1-3, before widespread use of surfactant and antenatal  steroids,  when  mortality  was  higher. SNAPPE (developed and mainly used in the Unit-ed States and Canada) can be applied to neonates of all BW and all GA2, whereas CRIB (developed in the United Kingdom and mainly used in Europe) can only be applied to VLBWI3. These score needs validation in different NICU set up. SNAP score as severity illness and mortality predictor9, SNAP II score as mortality and end organ dysfunction pre-dictor  and  CRIB  score  as  mortality  predictor  in very low birth weight babies less than 32 weeks of gestation has been validated in neonatal intensive care set up in India9-11, SNAPPE II score has not been  validated  in  intensive  care  units  in  India. SNAPPE II score, which was validated for neona-tal severity of illness and mortality in 2001 in Can-ada has an advantage that it has excellent discrimi-nation and goodness of fit in neonates of all the birth  weights5.  Although, in  another  study  CRIB and CRIB-II was found to have greater discrimina-tory  ability  than  SNAPPE-II  in  very  low  birth weight infants8. In our study we did a piloting to see that whether the SNAPPE II score can be used in NICU set up in India and similar to the study by Richardson5 in our study also those with the score >40 had a mortality in 37.5% and those with score >80 had 100% mortality. This was a pilot study to assess the prediction of mortality using SNAPPE II score in level II NI-CU in Indian setup. Study with large sample size can be done to predict mortality for each range of score. REFERENCES 1.  Richardson  DK,  Gray  JE,  McGomick  MC,  Workman  K, Goldman DA. Score for neonatal acute physiology: a phy-siologic severity index for neonatal intensive care. Pediat-rics 1993; 91: 617-623. 2. Richardson DK, Phibbs CS, Gray JE, et al. Birth weight and illness severity: independent predictors of neonatal mortal-ity. Pediatrics 1993;91:969-975. 3.  The international Neonatal Network. The CRIB (Clinical Risk Index for Babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal in-tensive care units. Lancet 1993;342:193-198. 4. Parry G, Tucker J, Tarnow-Mordi W; UK Neonatal Staffing Study Collaborative Group. CRIB II: an update of the clin-ical  risk  index  for  babies  score.  Lancet  2003;361:1789-1791. 5. Richardson DK, Corcoran JD, Escobar GJ and Lee M SK. SNAP-II and SNAPPE-II: Simplified newborn illness se-verity and mortality risk scores. J Pediatr 2001; 138:92-100. 6. Rautonen J, Makela A, Boyd H, et al. CRIB and SNAP: as-sessing  the  risk  of  death  for  preterm  neonates.  Lancet 1994;343:1272–1273.         -               -               -               -               -       S. Jain, A. Bansal Dicle Tıp Derg / Dicle Med J Cilt/Vol 36, No 4, 333-335 335 7. Pollack MM, Koch MA, Bartel DA, et al. A comparison of neonatal mortality risk prediction models in very low birth weight infants. Pediatrics 2000; 105:1051-1057. 8. Gagliardi L, Cavazza A, Brunelli A, et al. Assessing mortal-ity risk in very low birthweight infants: a comparison of CRIB,  CRIB-II,  and  SNAPPE-II.  Arch  Dis  Child  Fetal Neonatal Ed 2004; 89:F419–F22. 9. Vasudevan A, Malhotra A, Lodha R, Kabra SK. Profile of neonates admitted in pediatric ICU and validation of Score for  Neonatal  Acute  Physiology  (SNAP).  Indian  Pediatr 2006 ;43:344-348 10. Sundaram V, Dutta S, Ahluwalia J and Narang A. Score for  neonatal  acute  physiology  II  predicts  mortality  and persistent organ dysfunction in neonates with severe sSep-ticemia. Indian Pediatr 2009 :46; 775-778. 11. Rastogi PK, Sreenivas V, Kumar N. Validation of CRIB II for  Prediction  of  Mortality  in  Premature  Babies.  Indian Pediatr In press 2009:             -               -               -               -               -       

Dicle Medical Journal / Dicle Tip Dergisi

SNAPPE II score for predicting mortality in a level II neonatal intensive care unit

https://jhaponline.org/jhap/article/view/14/13

SNAPPE II score for predicting mortality in a level II neonatal intensive care unit

Abstract

Similar works

Full text

Available Versions

Directory of Open Access Journals