Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE II) in Predicting Mortality and Morbidity in NICU.

Introduction: A number of illness severity scores have evolved which would predict mortality and morbidity in intensive care units. One such scoring system developed by Richardson was SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal extension-II). The present study was undertaken to determine the validity of SNAPPE II score in predicting outcome in terms of mortality and also determine morbidity in terms of duration of hospital stay using SNAPPE II score. Method: This prospective observational study was conducted in 186 neonates in Neonatal Intensive Care Unit (NICU), Department of Paediatrics, SNMC & HSK Hospital and Research centre, Bagalkot from 1st Dec 2016 to 31st May 2018. At admission, detailed clinical assessment of the baby was performed and recorded within 12 hours of admission in a pre-designed questionnaire. All the babies were subjected blood gas analysis to get pH and PaO2. And hence PaO2/ FiO2 ratio was calculated. Outcome was recorded based on baby’s survival and duration of hospital stay. Results: SNAPPE II score was higher among expired babies compared to survived babies. A mean score of 45.6 was associated with higher mortality had a sensitivity of 82.9%, specificity of 98.0%, positive predictive value of 90.2% and negative predictive value of 96.1%. AUC in ROC was found to be 0.960. Increased score resulted in increased duration of hospital stay. Conclusion: SNAPPE II score is a good predictor of neonatal mortality and morbidity in terms of duration of hospital stay.

Extended Spectrum Beta Lactamase producing Gram negative bacteria - An emerging menace in Neonatal Sepsis.

Introduction: Neonatal sepsis caused by extended spectrum beta lactamase (ESBL) producing Gram negative bacteria (GNB) is associated with significantly high mortality and morbidity. Clinical features and risk factors for such neonatal sepsis can help in identifying it early. Objectives: Aim of the study was to estimate the incidence, risk factors, clinical features and antibiotic sensitivity of GNB and outcomes of ESBL GNB in neonatal sepsis. Methodology: A prospective observational conducted at regional tertiary care health center. Statistical analysis was carried out with SPSS version 23.0. Results: A total of 87 cases of Gram negative neonatal sepsis were included in study. Male: female was 1.7:1. Forty nine (56.3%) isolates were ESBL positive strains. The clinical features in order of frequency were shock, lethargy, sclerema, disseminated intravascular coagulation and severe thrombocytopenia. Out born neonates (p=0.03), late onset sepsis (p=0.05) and mechanical ventilation (p=0.002) were the risk factors for ESBL GNB sepsis. Mortality associated with ESBL sepsis was 26.5%. Carbapenems and Piperacillin + Tazobactum were most sensitive antibiotics and high resistant for cephalosporins was observed. Conclusion: ESBL GNB neonatal sepsis is an emerging threat with high mortality in Neonatal Intensive care unit.