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Pediatría (Asunción)

On-line version ISSN 1683-9803


MESQUITA, Mirta; ALVAREZ, Elizabeth; GODOY, Laura  and  AVALOS, Sonia. SNAP II and SNAP-PE II Severity Scoring for Determining The Risk of Neonatal Mortality in a Polyvalent Intensive Care Unit. Pediatr. (Asunción) [online]. 2011, vol.38, n.2, pp.93-100. ISSN 1683-9803.

Introduction: Both SNAPPE SNAP II and II, are scores of disease severity for newborns admitted to neonatal intensive care units, validated to predict neonatal mortality. Objectives: To determine the validity of SNAP II and SNAPPE II as predictors of neonatal mortality and days of hospitalization in the polyvalent pediatric intensive care unit. Methodology: An analytical and observational study using a database of the records of newborns as the source of data and EPI INFO to calculate SNAP II and SNAPPE II according to the methodology of its author, within 12 hours of admission. All data was included from all patients. The data were analyzed with EPI INFO and SPSS 17, using the mean, percentages, ratios and the ROC curve for analysis of scores and linear regression. A level of 5% was deemed significant. Results: For calculation of SNAP II, 288 neonates were entered, with the SNAP II found calculable for 245 of them. Average postnatal age was 7±8 days and birth weight 2788±857 g, while 27% had intrauterine growth restriction (IUGR); 165 were home births and 54% were referred from another hospital; 28% had congenital anomalies, while 26% underwent surgery and 56% entered mechanical ventilation. A total of 24% died. The mean SNAP II was 5±6 in survivors vs. 15.5±12 in those who died (<0.0001). The average SNAPPE II was 8±10 in survivors vs. 21±15 in those who died (p<0.0001). these differences were maintained across all birth-weight groups. The area under the curve (Az) was 0.79 (0.72-0.85) for SNAP II and 0.77 (0.69-0.86) for SNAPPE II. The best cutoff was 9 for SNAP II (S=70%, E= 76%), and 12.5 for SNAPPE II (S=71% and E=75%). The relationship between the scores and days of hospitalization was analyzed by linear regression. For SNAP II r = 0 while for SNAPPE II r = 0.03. Conclusions: SNAP II and SNAPPE II were good predictors of neonatal mortality in infants with an average postnatal age of one week who were hospitalized in the polyvalent intensive care unit, but was not shown to be useful in predicting days of hospitalization.

Keywords : Severity of illness index; SNAP II; SNAP-PE II; neonatal mortality; neonatal intensive care; prognosis.

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