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Multicenter Study
. 2009 Nov;124(5):e1001-6.
doi: 10.1542/peds.2008-3233. Epub 2009 Oct 26.

Interinstitutional variation in prediction of death by SNAP-II and SNAPPE-II among extremely preterm infants

Olaf Dammann  1 , Bhavesh Shah, Mary Naples, Francis Bednarek, John Zupancic, Elizabeth N Allred, Alan Leviton; ELGAN Study Investigators
Affiliations
Multicenter Study

Interinstitutional variation in prediction of death by SNAP-II and SNAPPE-II among extremely preterm infants

Olaf Dammann et al. Pediatrics. 2009 Nov.

Abstract

Background: Illness severity scores predict death among infants admitted to NICUs. We know of no study limited to a population defined by an extremely low gestational age.

Methods: A total of 1467 infants born before the 28th postmenstrual week at 14 institutions were given Score for Neonatal Acute Physiology II (SNAP-II) and Score for Neonatal Acute Physiology Perinatal Extension II (SNAPPE-II) values based on data collected within the first 12 postnatal hours. All deaths in the intensive care nursery were identified.

Results: The rate of death before postnatal day 28 was 13% (interinstitutional range: 7%-20%), whereas the overall mortality rate was 18% (8%-31%). SNAP-II values, SNAPPE-II values, and mortality rates tended to decrease with increasing gestational age. Even within gestational age strata, however, the risk of death decreased with decreasing SNAP-II and SNAPPE-II values. The positive predictive values of most SNAP-II and SNAPPE-II cutoff levels were close to 30%. In general, institutions' mortality rates increased with the proportions of infants whose SNAP-II values were >/=30.

Conclusion: The physiologic instability in the first 12 postnatal hours that is identified by illness severity scores conveys information about the risk of death among infants at the lowest gestational ages.

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Conflict of interest statement

Financial disclosures and conflicts of interest: Dr. Zupancic is employed by the Beth Israel Deaconess Medical Center, which, along with the University of British Columbia and Kaiser Permanente Health Care Systems, holds the patent for the revised Score for Neonatal Acute Physiology.

Figures

Figure 1
Figure 1
Box and whiskers plot of SNAPs at each week of gestational age presented separately for newborns who died in the first month and those who survived. The central tendency is indicated by the line close to the middle of the box, which is the median, and by the top and bottom of each box, which indicate the 25th and 75th centiles. The scatter of SNAP-IIs is indicated by the length of the vertical lines that emanate from the box, as well as by the dots, which identify outliers. The median line for the 27-week newborns who died is superimposed on the line for the 25th centile. * Wilcoxon rank-sum p=0.003; ** p=0.001; *** p<0.001; § p=0.09. The relationship between gestational age and SNAP-IIs was significantly different across gestational ages, with Chi-square p-values for trend of p<0.0005 for all observations, p<0.0005 for survivors, and p=0.001 for infants who died.
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