Valor preditivo dos escores de SNAP e SNAP-PE na mortalidade neonatal

Abstract

ResumoObjetivos: avaliar os escores SNAP e SNAP-PE como preditores de mortalidade neonatal na nossa UTI neonatal, comparando seus resultados.Métodos: todos os recém-nascidos admitidos na UTI neonatal no período de março de 1997 a dezembro de 1998 foram avaliados prospectivamente quanto ao SNAP e SNAP-PE com 24 horas de vida. Foram critérios de exclusão o óbito ou alta da UTI nas primeiras 24 horas de vida, as malformações congênitas incompatí-veis com a vida, e recém-nascidos transferidos de outros hospitais.Resultados Methods: All newborn infants admitted to our neonatal intensive care unit from March 1997 through December 1998 were prospectively evaluated just at completion of 24 hours of life for SNAP and SNAP-PE. Exclusion criteria were: death or discharge from the neonatal intensive care unit in the first 24 hours of life, congenital malformations incompatible with life, and outborn infants.Results: 553 newborn infants were included in the study and 54 died. The median SNAP and SNAP-PE values were higher in those who died. Infants were allocated to five different raising ranges of SNAP and SNAP-PE severity.SNAP: up to 6, 7-11, 12-15, 16-24, higher than 24 (mortality: 3%, 11%, 29%, 48%,75%, respectively). [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50], higher than 50 (mortality: 3%, 10%, 53%, 78%, 83%, respectively). The optimal cut off points based on ROC curve were 12 for SNAP, and 24 for SNAP-PE. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for death were figured out. SNAP 12: sensitivity 79.6%, specificity 71.7%, PPV 23.4%, NPV 97%. SNAP-PE 24: sensitivity 79.6%, specificity 80%, PPV 30%, NPV 97.3%. The area under the curve (Az) were 81.4% for SNAP, and 85.1% for SNAP-PE, both statistically significant. There were no statistical differences between the two areas under the curve.Conclusions: SNAP and SNAP-PE are excellent predictors of neonatal survival. Therefore, we recommend their use in Neonatal Intensive Care Units.J Pediatr (Rio J) 2001; 77 (6): 455-60 IntroduçãoO baixo peso de nascimento foi classicamente descrito na literatura como o maior determinante da mortalidade neonatal em 1930, quando acreditava-se que recém-nascidos pesando 2.500g ou menos apresentavam um risco

Score for Neonatal Acute Physiology and Perinatal Extension II as a Predictor of Retinopathy of Prematurity: Study in 304 Very-Low-Birth-Weight Preterm Infants

“…Comparative studies between various neonatal illness severity scores for mortality and comorbidities among preterm babies were previously published from our NICU at the HCPA in 2001 and 2003 [7, 12]. In Brazil, these scoring systems have become increasingly important considering survival rates, especially among VLBW and extremely low-BW preterm babies (babies with BW <1,000 g), because the Brazilian survival rates are lower than those reported in industrialized countries [11, 12].…”

Noise at the Neonatal Intensive Care Unit and inside the incubator

“…This criterion was adopted because this score assesses the risk of neonatal mortality (12) . During this period, the dosimeter was transferred to another incubator twice, as a result of the need for the newborn to leave the NICU.…”

O ruído da unidade de terapia intensiva neonatal após a implementação de programa educativo

“…This criterion was adopted because such score evaluates the risk for neonatal mortality. 20 The four dosimeters, with capability to record the SPL minute by minute, were configured as follows: slow response time (slow), measuring the sound pressure level in decibel (dB) and the reflection in frequency A dB (A). 21 The scale A (dBA) is the filtering method that mimics the reception characteristics of the human ear, and it is indicated to the seizure of continuous noise of equivalent sound pressure level (Leq).…”