Prediction of ECMO and Mortality in Neonates with Congenital Diaphragmatic Hernia Using the SNAP-II Score

Kipfmueller, Florian; Schroeder, Lukas; Melaku, Tamene; Geipel, A.; Berg, Christoph; Gembruch, Ulrich; Heydweiller, Andreas; Bendixen, Charlotte; Reutter, Heiko; Müller, Andreas

doi:10.1055/a-1009-6671

Cited by 10 publications

(11 citation statements)

References 28 publications

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“…A prospective trial assessing the initial ventilation strategy in CDH infants showed the predictive value of SNAP-II for both mortality as well as the need for extracorporeal membrane oxygenation (ECMO) 40. The SNAP-II Score is easy to use and its potential as early predictor was also confirmed in a more recent retrospective study 41…”

Section: Delivery Room Management: Novel Conceptsmentioning

confidence: 94%

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Perinatal stabilisation of infants born with congenital diaphragmatic hernia: a review of current concepts

Horn-Oudshoorn

Knol

Pas

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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Congenital diaphragmatic hernia (CDH) is associated with high mortality rates and significant pulmonary morbidity, mainly due to disrupted lung development related to herniation of abdominal organs into the chest. Pulmonary hypertension is a major contributor to both mortality and morbidity, however, treatment modalities are limited. Novel prenatal and postnatal interventions, such as fetal surgery and medical treatments, are currently under investigation. Until now, the perinatal stabilisation period immediately after birth has been relatively overlooked, although optimising support in these early stages may be vital in improving outcomes. Moreover, physiological parameters obtained from the perinatal stabilisation period could serve as early predictors of adverse outcomes, thereby facilitating both prevention and early treatment of these conditions. In this review, we focus on the perinatal stabilisation period by discussing the current delivery room guidelines in infants born with CDH, the physiological changes occurring during the fetal-to-neonatal transition in CDH, novel delivery room strategies and early predictors of adverse outcomes. The combination of improvements in the perinatal stabilisation period and early prediction of adverse outcomes may mitigate the need for specific postnatal management strategies.copyright.on July 4, 2020 by guest. Protected by

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Section: Delivery Room Management: Novel Conceptsmentioning

confidence: 94%

“… 40 The SNAP-II Score is easy to use and its potential as early predictor was also confirmed in a more recent retrospective study. 41 …”

Section: Delivery Room Management: Novel Conceptsmentioning

confidence: 99%

Perinatal stabilisation of infants born with congenital diaphragmatic hernia: a review of current concepts

Horn-Oudshoorn

Knol

Pas

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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“…Nhiều nghiên cứu đã chứng minh được vai trò của thang điểm SNAP-II trong việc đánh giá tiên lượng tử vong trong nhiều bệnh lý như thoát vị hoành bẩm sinh, xuất huyết não, trẻ sinh non [8,9]. Điểm số SNAP-II trung bình của cả nghiên cứu là 29,9 ±12,3, cao hơn so với nghiên cứu của Narongsak Nakwan là 25,0 ±12,1 [11].…”

Section: Bàn Luậnunclassified

Predicting Outcome in Persistent Pulmonary Hypertension of the Newborn with Score for Neonatal Acute Physiology- Version II (SNAP-II)

Hieu

Dien²,

Hà³

2021

MPS

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Persistent pulmonary hypertension of the Newborn is a serious disease related to the adaptation of fetal circulation after birth. This study aims to determine the ability of Score for Neonatal Acute Physiology- version II (SNAP-II) for predicting outcome in neonates with persistent pulmonary hypertension of the newborn (PPHN). This prospective cohort study of 52 neonates with PPHN was carried out in the Neonatal Center and Surgical Intensive Care Unit, Vietnam National Children’s Hospital over a period of 7 months (10/2020 to 4/2021). SNAP-II score was evaluated within the first 12 hours of admission. Outcome of treatment was recorded at the 28th day of treatment. The study results show that the mortality rate was 25.0%; 11.5% of the patients had to use ventilators; 28.8% of the patients used NO inhalers and 9;6% of the patients required ECMO. SNAP-II score has the power of predicting mortality in PPHN with the area under the ROC curve of 0.76 (95% CI: 0.61- 092, p < 0.05). SNAP-II score ≥ 27 was calculated as cutoff for predicting mortality with the sensitivity of 92;3% and specificity of 53.8%. Each point increase in SNAP-II score increased the odd of mortality by 1.10 (95% CI: 1.03- 1.18, p< 0.05). SNAP-II score also has the ability of predicting secondary outcome of PPHN: using ECMO (AUC 0.81). Notably, this study finds that the SNAP-II scoring system is a useful and reliable tool to predict mortality of neonates with PPHN and to assess the need of ECMO therapy. Keywords: Persistent pulmonary hypertension of the newborn, Score for Neonatal Acute Physiology- version II, neonatal mortality. References [1] J. Nair, S. Lakshminrusimha, Update on PPHN: Mechanisms and Treatment, Seminars in Perinatology, Vol. 38, No. 2, 2014, pp. 78-91, https://doi.org/10.1053/j.semperi.2013.11.004.[2] M. A. Steurer, R. J. Baer, S. Oltman, K. K. Ryckman, S. K. Feuer, E. Rogers, R. L. Keller, L. Jelliffe- Pawlowski, Morbidity of Persistent Pulmonary Hypertension of the Newborn in The First Year of Life, Journal of Pediatric, Vol. 213, 2019, pp. 58-65, https://doi.org/10.1016/j.jpeds.2019.06.053.[3] N. Nakwan, N. Nakwan, J. Wannaro, Predicting Mortality in Infants with Persistent Pulmonary Hypertension of the Newborn with The Score for Neonatal Acute Physiology-Version II (SNAP-II) in Thai Neonates, Journal of Perinatal Medicine, Vol. 39, No. 3, 2011, pp. 311-315, https://doi.org/10.1515/jpm.2011.011.[4] D. K. Richardson, J. D. Corcoran, G. J. Escobar, G. J. Escobar, S. K. Lee, SNAP-II and SNAPPE-II: Simplified Newborn Illness Severity and Mortality Risk Scores, The Journal of pediatrics, Vol. 138, No. 1, 2001, pp. 92-100, https://doi.org/10.1067/mpd.2001.109608.[5] S. Sardar, S. Pal, R. Mishra, A Retrospective Study on The Profile of Persistent Pulmonary Hypertension of Newborn in A Tertiary Care Unit of Eastern India, Journal of Clinical Neonatology, Vol. 9, No. 1, 2020, pp. 18-26, https://doi.org/10.4103/jcn.JCN_68_19.[6] M. Sauthier, L. Rose, P. Jouvet, Pediatric Prolonged Mechanical Ventilation: Considerations for Definitional Criteria, Respiratory care, Vol. 62, No. 1 2017, pp. 49-53, https://doi.org/10.4187/respcare.04881.[7] M. N. M. Bah, R. Y. H. Tan, H. Razak, M. H. Sapian, N. Abdullah, E. Y. Alias, Survival and Associated Risk Factors for Mortality among Infants with Persistent Pulmonary Hypertension of The Newborn in Malaysia, Journal of Perinatology, Vol. 41, 2021, pp. 786-793, https://doi.org/10.1038/s41372-021-00962-6.[8] E. D. Skarsgard, Y.C. MacNab, Z. Qiu, R. Little, S. K. Lee, SNAP-II Predicts Mortality among Infants with Congenital Diaphragmatic Hernia. Journal of Perinatology, Vol. 25, No. 5, 2005, pp. 315-319, https://doi.org/10.1038/sj.jp.7211257.[9] L. Y. Chien, R. Whyte, P. Thiessen, R. Walker, D. Brabyn, S. K. Lee, SNAP-II Predicts Severe Intraventricular Hemorrhage and Chronic Lung Disease in The Neonatal Intensive Care Unit, Journal of Perinatology, Vol. 22, No. 1, 2002, pp. 26-30, https://doi.org/10.1038/sj.jp.7210585.[10] S. Jaroensri, W. Kamolvisit, N. Nakwan, Risk Factor Analysis of Pneumothorax Associated with Persistent Pulmonary Hypertension of The Newborn in Thai Neonates, The Journal of Maternal-Fetal & Neonatal Medicine, Vol. 33, No. 24, 2020, pp. 4090-4095, https://doi.org/10.1080/14767058.2019.1596403.[11] F. Kipfmueller, L. Schroeder, T. Melaku, A. Geipel, C. Berg, U. Gembruch, A. Heydweiller, C. Bendixen, H. Reutter, Prediction of ECMO and Mortality in Neonates with Congenital Diaphragmatic Hernia Using The SNAP-II Score, Klinische Pädiatrie, Vol. 231, No. 6, 2019, pp. 297-303, https://doi.org/10.1055/a-1009-6671.

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“…Management of newborn infants with CDH requires a high skill set, with multidisciplinary team involvement, starting from the point of antenatal diagnosis. Despite improved outcomes over the years [3], morbidity and mortality remain high (20-40%), even in high volume tertiary referral centers [4,5]. A quarter of survivors suffer neurodevelopmental impairment involving all domains, and ranges from motor and sensory (hearing, visual) deficits to cognitive, language, and behavioural impairment [6].…”

Section: Introductionmentioning

confidence: 99%

The Utility of Serial Echocardiography Parameters in Management of Newborns with Congenital Diaphragmatic Hernia (CDH) and Predictors of Mortality

Soni

Chakkarapani

et al. 2022

Pediatr Cardiol

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Ventricular dysfunction may be found in 40% of newborns with CDH, and is not only a predictor of disease severity, but also mortality and need for ECMO. We conducted this study to assess the utility of serial echocardiography in management of newborns with CDH and their survival outcomes. This is a retrospective study, wherein the demographic, clinical and echocardiographic data from our local CDH registry and hospital clinical database were analyzed to study the correlation of timed echocardiographic findings with mortality and other outcomes. Fourty-two newborns with CDH were admitted during the study period (M/F:19/23), with median gestation of 38 weeks (IQR:36–39) and birth weight of 2.83 kg (IQR 2.45–3.17). Thirty-one were left-sided, seven right, one central, and three bilateral hernias. Twelve infants (28%) died in early infancy. Three infants were excluded from analysis due to either palliation at birth or significant cardiac anomaly. A total of 137 echos from 39 infants were analyzed. Seventy percent of newborns who died and had an echo within the first 72 h, were noted to have suffered from moderate to severe PH. Birth weight < 2.8 kg, RVSP > 45.5 in the first 72 h and postoperative VIS > 23.5 and RSS > 4.3 were good predictors of mortality. Markers of elevated pulmonary pressures and cardiac function were useful in guiding therapy. Serial timed functional echocardiography (f-Echo) monitoring allows targeted therapy of patients with CDH. Birth weight, initial severity of pulmonary hypertension and postoperative RSS and VIS may be useful in predicting mortality.

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Prediction of ECMO and Mortality in Neonates with Congenital Diaphragmatic Hernia Using the SNAP-II Score

Cited by 10 publications

References 28 publications

Perinatal stabilisation of infants born with congenital diaphragmatic hernia: a review of current concepts

Perinatal stabilisation of infants born with congenital diaphragmatic hernia: a review of current concepts

Predicting Outcome in Persistent Pulmonary Hypertension of the Newborn with Score for Neonatal Acute Physiology- Version II (SNAP-II)

The Utility of Serial Echocardiography Parameters in Management of Newborns with Congenital Diaphragmatic Hernia (CDH) and Predictors of Mortality

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