Snap II and Snappe II scores as predictors of mortality in a level III neonatal intensive care unit in India: an...

The predictive utility of Score for Neonatal Acute Physiology (SNAP) II and SNAP-Perinatal Extension (SNAPPE) II scores has not yet been validated in regions contributing significantly to the national neonatal mortality rate of India such as the Eastern Zone of Uttar Pradesh. The cut-off value of these scores varies with the institution. The use of unit-specific cut-off values leads to better prediction of neonatal mortality with improved specificity and sensitivity. To assess the validity of SNAP II and SNAPPE-II scoring systems and compare these two methods for predicting mortality in newborns admitted to neonatal intensive care unit (NICU), prospective observational study was conducted from July 2018 to June 2019. Newborns admitted within 24 hours of birth with > 12-hour length of hospital stay in NICU were included. Babies with major congenital malformations and whose parents did not give consent were excluded. The variables for SNAP II and SNAPPE II scores were collected within the window period of the first 12 hours. The mean SNAP-II and SNAPPE II score was 38.5 ± 18.3 and 51.1 ± 25.7 among expired babies compared to survived babies with a mean score of 15.79 ± 13.6 and 18.52 ± 16.3, respectively. Both of these scores had a strong correlation with patients' survival (p < 0.001). The SNAP II score of ≥ 27 and SNAPPE-II score of ≥39 had a sensitivity of 81% and 73% and specificity of 80.6% and 88.6%, respectively for predicting neonatal mortality. Both SNAP II and SNAPPE II are useful tools for predicting NICU neonatal mortality.