Improved SNAPPE-II and CRIB II scores over a 15-year period

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Perinatal Epidemiology

Background:

• Global declines in preterm infant mortality and morbidity have been observed over recent decades.
• Improvements in neonatal intensive care are hypothesized to contribute to better outcomes.

Purpose of the Study:

• To investigate the association between changes in illness severity scores and outcomes in preterm infants over a 15-year period.
• To determine if advancements in care have reduced mortality and morbidity in very preterm infants.

Main Methods:

• Retrospective analysis of inborn infants (gestational age 26+0 to 28+6 weeks) from two cohorts (1997-1999 and 2006-2011).
• Comparison of Score for Neonatal Acute Physiology Perinatal Extension-II (SNAPPE-II) and CRIB II scores, mortality, severe morbidity, and survival without morbidity between periods.
• Multivariable analysis to assess outcomes adjusted for illness severity.

Main Results:

• SNAPPE-II scores significantly decreased in the later period, while CRIB II scores did not change.
• The risk of mortality for given SNAPPE-II and CRIB II scores remained consistent between the two periods.
• The risk of morbidity significantly decreased, and survival without morbidity significantly increased in the later period for comparable illness severity scores.

Conclusions:

• Illness severity assessment scores, specifically SNAPPE-II, have improved for preterm infants over 15 years.
• While mortality risk for similar severity scores has not changed, the risk of morbidity has decreased, leading to better survival without complications.
• These findings highlight significant advancements in obstetrical and neonatal care practices.