Usefulness of Serial Algorithms of Illness Severity as a Proxy for Impending Death in the NICU: Not Much ♦ 157

Frain, Laura; Soneji, Samir; Ren, Yaya; Yoon, Grace; Bobila, Kris; Kapustka, Heidi; B, Grant; Lantos, John D.; Meadow, William

doi:10.1203/00006450-199804001-00178

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“…We observed that Δ SNAP-II_0-48, although signi cantly higher in non-survivors, had an average discriminative ability (AUROC: 0.70). This is similar to the observations made by Frain et al, where the ability of serial SNAP-II scores to predict mortality in neonates requiring mechanical ventilation decreased with time [13]. A systematic review on serial severity scores in neonates showed that in majority of the studies, SNAP-II scores were done only at admission to ICU and were used to predict mortality on rst day of life.…”

Section: Discussionsupporting

confidence: 85%

“…Meadow et al showed that serial SNAP-II scores in premature neonates became progressively less helpful in distinguishing neonates who either died in the NICU or survived with low Mental/Psychomotor Developmental Index scores [12]. In another study, in neonates requiring mechanical ventilation, serial SNAP scores did not predict mortality, but admission SNAP scores did predict [13]. Severe sepsis/septic shock is one of the major causes for mortality in preterm neonates.…”

Section: Introductionmentioning

confidence: 99%

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Repeated measurements are not better than initial measurement of Score for Neonatal Acute Physiology-II for prediction of in-hospital mortality in severely septic preterm neonates

Anne

Sundaram²,

Kumar

2021

Preprint

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The ability of serial versus single time application of ‘Score for Neonatal Acute Physiology, version II’ (SNAP-II) to predict mortality at day 14 in preterm neonates < 34 weeks with severe sepsis was studied prospectively over 1-year in a tertiary care neonatal unit. SNAP-II scores were recorded at the onset of severe sepsis (T0) and serially at 24 (T1), 48 (T2) and 72 (T3) hours later. Delta scores (Δ SNAP-II) were derived from the difference between any two SNAP-II scores. Seventy-one preterm neonates were enrolled. Baseline characteristics were similar in survivors (n = 53) and non-survivors (n = 18). Median SNAP-II scores at all the four time points were significantly higher in non-survivors (p < 0.001). The Δ SNAP-II (T0 – T2) score was significantly different between non-survivors and survivors (mean difference: -14.7; 95% CI: -29, -0.9; p = 0.02), while the difference was not significant between T0 – T1 and T0 – T3. Initial SNAP-II score had a significantly better discriminating ability for day 14 mortality (AUC (95% C.I): 0.83 (0.70–0.93)) than Δ SNAP-II scores at various time points (AUC (95% C.I): 0.59 (0.41–0.75) for T0 – T1, 0.70 (0.50–0.87) for T0 – T2 and 0.64 (0.38–0.89) for T0 – T3). Conclusion: Initial SNAP-II is better than Δ SNAP-II scores in predicting 14-day mortality in severely septic preterm neonates. Non-survivors had a significantly higher serial SNAP-II scores compared to survivors. Serial SNAP-II score do not have additional value in predicting mortality of preterm neonates with severe sepsis.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%