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.

Evaluation of Heart Rate Variability in Critically-ill Neonates

Aims: The objective of this work was to evaluate heart rate variability (HRV) in critically-ill neonates admitted to NICU, to detect the effect of different causes of critical illness on cardiac autonomic function and outcome of these neonates.Study Design:Case-control study.Place and Duration of Study:Neonatal Intensive Care Unit (NICU) of Pediatric Department, Tanta University Hospital, in the period from January 2018 to May 2019.Methodology:We included 30 neonates who were critically-ill according to Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE-II score) as cases Group. Fifteen healthy full term neonates, matched for age and sex, were enrolled as a control group. 24-hour Holter monitoring was performed with recording and interpretation of ECG data for every neonate in the study, including analysis of HRV.Results:There was significant increase of mean HR in critically-ill neonates as compared to control group. There was significant decrease of all HRV parameters (SDNN, SDANN, SDNNI, RMSSDand PNN50) in critically-ill neonates as compared to control group (P< 0.05). Significant negative correlations between SNAPPE-II score and HRV parameters (SDNN, SDANN, SDNNI, RMSSD, PNN50) in critically-ill neonates were present, whereas there was non-significant positive correlation between SNAPPE-II score and mean heart rate.Conclusion:HRV parameters decreased significantly in critically-ill neonates admitted to NICU, denoting severe cardiac autonomic dysfunction in these sick newborn infants. HRV strongly correlated to severity (SNAPPE-II score) and outcome, with strong relation to mortality of these critically-ill neonates

SNAPPE II score: predictor of mortality in NICU

Background: Advances in the NICU (neonatal intensive care unit) have significantly decreased mortality and morbidity and increased survival rate in neonates. SNAPPE II (Score for Neonatal Acute Physiology-Perinatal Extension II) score, which is a modified version of the SNAP score (Score for Neonatal Acute Physiology) helps in predicting the neonatal mortality. The aim of the study was to assess the risk of mortality using SNAPPE II score in neonates admitted to NICU.Methods: It was a prospective validation study done in a tertiary care hospital. Data was collected from 116 new borns admitted to NICU within 48 hours of birth who required respiratory support between December 2017 to June 2018.Results: A total of 116 newborns admitted to the NICU was included in present study. Out of 116 babies, 56 (48%) had mild SNAPPE-II score, 44 (38%) had moderate score and 16 (14%) had severe score. Among the 44 babies with moderate score, 12 (27%) died, which was statistically significant (P<0.001). Among 16 babies with severe score, 13 (81%) babies died, which was highly statistically significant (P<0.0001). Urine output, seizures, serum pH in the first 24 hours of life are independent predictors of mortality with significant p value (0.001).Conclusions: The SNAPPE-II score recorded in the first 48 hours of life could be a good predictor of mortality in babies admitted to NICU.

Extended Sick Neonate Score (ESNS) for Clinical Assessment and Mortality Prediction in Sick Newborns referred to Tertiary Care

Objective:To evaluate utility of a new Extended Sick Neonate Score (ESNS). to predict ‘in-hospital mortality’ and compare with Score for Neonatal Acute Physiology – PerinatalExtension II (SNAPPE II) and Sick Neonate Score (SNS). Design:Prospective observationalstudy. Methods:All extramural sick newborns transported to the neonatology unit of a tertiarycare teaching hospitalover a period of one year.Correlation between ESNS, SNAPPE-II andSNS scoring, and sensitivity/specificity of each score to predict mortality were determined.Results:961 newborns were enrolled in the study. ESNS, SNAPPE II and SNS were stronglycorrelated, even when stratified by gestation. ESNS of ≤11 had the best sensitivity (85.9%)and specificity (89.8%). For preterms, ESNS ≤12 had the best sensitivity (92.3%) andspecificity (76.7%). Conclusion:ESNS can predict ‘in-hospital mortality’ outcome withsatisfactory sensitivity and specificity