Score For Neonatal Acute Physiology-II Research Articles

Change in Score for Neonatal Acute Physiology-II Measurements for Prediction of Mortality in Severely Septic Preterm Neonates.

To study the discriminatory ability of the change (delta) in the Score for Neonatal Acute Physiology-II (SNAP-II) for 14-d mortality in preterm neonates with severe sepsis. Consecutively born neonates of < 34-wk gestation during the 1-y study period in a tertiary care neonatal unit were included. SNAP-II was recorded at the onset of severe sepsis (T0) and serially at 24 (T1), 48 (T2), and 72 (T3) h. Delta scores (Δ SNAP-II) were derived from the difference between the SNAP-II at baseline and each one of the subsequent time points. Seventy-one preterm neonates were enrolled. Baseline characteristics were similar in survivors (n = 53) and nonsurvivors (n = 18). Median SNAP-II at all the four time points were significantly higher in nonsurvivors (p < 0.001). Delta SNAP-II (T0-T2) was significantly different between nonsurvivors and survivors (mean difference: -14.7; 95% CI: -29, -0.9; p = 0.02), while the difference was not significant between T0-T1 and T0-T3. Initial SNAP-II had a significantly better discriminating ability than Δ SNAP-II at various time points (AUC, 95% CI: 0.59, 0.41-0.75 for T0-T1; 0.70, 0.50-0.87 for T0-T2; and 0.64; 0.38-0.89 for T0-T3). Delta SNAP-II does not have a better discriminatory ability for mortality by 14 d in preterm neonates with severe sepsis.

Clinical risk index of babies-II versus score for neonatal acute physiology-II in predicting mortality and morbidity in preterm babies

Background: The measurement of severity of illness using scoring systems is an important aspect in predicting mortality and morbidity in intensive care units which in turn can help in optimizing the limited healthcare resources in developing countries. The primary objective was to determine the correlation between clinical risk index of babies-II (CRIB-II) and score for neonatal acute physiology-II (SNAP-II) scores while the secondary objective was to identify which among them is superior in predicting mortality and morbidity in preterm neonates.Methods: The components of CRIB-II and SNAP-II scores were recorded prospectively over a period of 1 year in preterm very low birth weight (VLBW) babies and receiver-operating-characteristics (ROCs) were plotted for comparison. Correlation between CRIB-II and SNAP-II was examined by Pearson technique. The ability of CRIB-II and SNAP-II scores to correctly predict mortality, was assessed by calculating ROCs and their associated area under the curve (AUC).Results: Thirty nine neonates with a mean birth weight of 994.10 grams (SD±273.45 grams) and mean gestational age of 28.07 weeks (SD±2.29 weeks) were included in this study. The mean value of CRIB-II score and SNAP-II score was 8.54 (SD±4.67) and 9.82 (SD±8.93) respectively with a Pearson coefficient of 0.483 showing a modest correlation. CRIB-II (AUC 0.909) showed greater discrimination than SNAP-II (0.869) as a predictor of mortality. However, both the scores have poor discrimination when it comes to predicting neonatal morbidity.Conclusions: CRIB-II with its simplicity, need for uncomplicated variables and minimal time to generate a score for prediction of mortality and morbidity could be a useful tool in a busy neonatal intensive care unit (NICU).

Targeting Risk Factors for the Control of Central Line-Associated Bloodstream Infection in the Neonatal Intensive Care Unit: A Single Tertiary Center Experience

Purpose: The aim of this study was to estimate the effect of targeting risk factors for the control of central line-associated bloodstream infection (CLABSI) among high-risk infants in a tertiary neonatal intensive care unit (NICU).Methods: Infants admitted to the NICU and diagnosed with CLABSI from January to December 2013 were eligible for inclusion to the study. The CLABSI group (n=47) was matched in a 1:2 ratio to the control group (n=94) based on gestational age, birth weight, and Score for Neonatal Acute Physiology-II. Risk factors for CLABSI were identified using the Cox proportional hazard model, and analysis of the effect of these risk factors targeting infection control was performed.Results: The risk factors associated with CLABSI were prolonged central line dwell days (adjusted hazard ratio [HR], 1.028; 95% confidence interval [CI], 1.011 to 1.045; P=0.001), use of a silicone catheter (adjusted HR, 5.895; 95% CI, 1.893 to 18.355; P=0.002), surgical treatment (adjusted HR, 3.793; 95% CI, 1.467 to 9.805; P=0.006), and less probiotic supplementation (adjusted HR, 0.254; 95% CI, 0.068 to 0.949; P=0.042). By targeting these risk factors with a quality improvement initiative, the mean CLABSI incidence rate per 1,000 catheter-days decreased from 6.6 to 3.1 (P=0.004).Conclusion: Targeting risk factors for infection control significantly reduced the rate of CLABSI among high-risk infants in the NICU.

Severity Index of Neonatal Septicemia in Neonatal Intensive Care units Using Score for Neonatal Acute Physiology-II

Background This study aimed to evaluate the competence of the score for neonatal acute physiology (SNAP-II) as a tool to anticipate morbidity and mortality of neonates with early or late sepsis in neonatal intensive care units (NICUs).Methods This prospective cohort study was conducted on all neonates of > 32 weeks with sepsis in tertiary NICUs at Cairo University Children Hospital and El Galaa Hospital For Armed Forces Officers Families, Cairo, Egypt, within May-October 2019. The eligible samples consisted of 100 neonates with septicemia who met inclusion and exclusion criteria and were enrolled. the score for neonatal acute physiology-II was calculated within 24 h of sepsis onset and followed up for 2 weeks for mortality and organ dysfunction (OD). The collected data were analyzed in SPSS software (version 25).Results It was revealed thatSNAP-II was significantly higher in neonates who passed away, compared to the survived neonates (46±17 vs. 12±10, respectively; P<0.001). Moreover, SNAP-II was significantly higher in neonates who developed OD within 14 days of sepsis onset, compared to those without OD (37±17 vs. 9±7, respectively; P<0.001). The score for neonatal acute physiology-II at 14.5 was considered the best cut-off point in predicting OD with a sensitivity of 100%, positive predictive value of 70.4%, specificity of 81.2%, and negative predictive value of 100%. In addition, SNAP-II at 23.5 was considered the best cut-off point in predicting overall mortality with 100% sensitivity, 58.6% PPV, 85.5% specificity, and 100% NPV.Conclusion Higher SNAP-II within 24 h of the early- or late-onset neonatal sepsis was a reliable predictor of OD and death.

Parent-reported health status of preterm survivors in a Canadian cohort

ObjectivesHealth status (HS)/ health-related quality of life measures, completed by self or proxy, are important outcome indicators. Most HS literature on children born preterm includes adolescents and adults with limited...

Relationships between Early Nutrition, Illness, and Later Outcomes among Infants Born Preterm with Hyperglycemia

To evaluate the effects of hyperglycemia on body composition and neurodevelopment, and how early nutrition and illness modify these relationships in infants born preterm. Prospective data were collected from infants born <32weeks of gestational age (N=97), including inpatient days of hyperglycemia (blood glucose >150mg/dL) and nutrient intake. Body composition was measured at discharge and 4months' postmenstrual age (PMA). Bayley Scales of Infant Development III (BSID-III) were administered at 12months' PMA. Linear regression analysis was performed, adjusting for birth gestational age. Associations between hyperglycemia, body composition, and BSID-III were analyzed in models accounting for first-week nutrition and early illness severity via Score for Neonatal Acute Physiology-II. Mean birth gestational age was 27.8 (SD 2.4) weeks. Hyperglycemia occurred in 48.5% of infants. Hyperglycemia for ≥5days was negatively associated with fat mass and fat free mass z scores at discharge, and fat free mass z score at 4months' PMA (P<.05 all). Hyperglycemia for ≥5days was negatively associated with cognition, language, and motor scores on the BSDI at 12months (P≤.01 all). Associations with body composition and BSID-III were diminished when models included first week nutrition yet remained unchanged when illness severity was included. In infants <32weeks, ≥5days of hyperglycemia is associated with decreased lean mass at 4months' PMA and poorer neurodevelopmental outcome at 12months' PMA. These associations may be mediated by decreased first week nutrition, potentially related to reduced glucose infusion rate for management of hyperglycemia.

Predictive ability of neonatal illness severity scores for early death in extremely premature infants

Background The predictive ability of neonatal illness severity scores for mortality or morbidity in extremely premature infants has not been extensively studied. We aimed to evaluate the ability of neonatal illness severity scores [Clinical Risk Index for Babies II (CRIB II), Score for Neonatal Acute Physiology II (SNAP-II), and SNAP-Perinatal Extension II (SNAPPE-II)] in predicting mortality and short-term morbidity of extremely premature infants. Methods This retrospective study involved 171 infants with gestational age (GA) between 22 and 27 weeks who were admitted to the NICU during 2010–2017. Predictive ability of neonatal illness severity scores for mortality and short-term morbidity (bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage, necrotizing enterocolitis, and gastrointestinal perforation) was assessed by comparing their area under the receiver operating characteristic curve. Results The overall mortality rate was 11.1%. Mortality at 23 weeks’ gestation was higher than that at 24–27 weeks’ gestation (p < .01, adjusted residual 4.5). Neonatal illness severity scores were significantly higher in infants who died than in those who survived (p < .01). CRIB II (AUC 0.93, 95% CI 0.85–1.00), SNAP-II (AUC 0.90, 95% CI 0.76–1.00), and SNAPPE-II (AUC 0.95, 95% CI 0.91–0.99) appeared to be excellent predictors and were superior to birth weight (AUC 0.88, 95% CI 0.80–0.95) or GA (AUC 0.84, 95% CI 0.72–0.96) alone in predicting early death (died on <28th postnatal day). CRIB II, SNAP-II, and SNAPPE-II were better predictors of early death than mortality in extremely premature infants. Neonatal illness severity score and short-term morbidity were not strongly associated. Conclusions The neonatal illness severity scores were excellent predictors of early death in extremely premature infants and might be useful for selecting extremely preterm infants who need intervention.

Pertinence of score for neonatal acute physiology-II to prognosticate mortality and organ dysfunction in neonatal sepsis

Introduction: The present investigation was undertaken to correlation between mortality and morbidity (organ dysfunction [OD]) and score for neonatal acute physiology-II (SNAP-II). Materials and Methods: A prospective investigation of newborns neonates, a total 157 neonates 82 male (52.2%), female 75 (47.8%) were enrolled and disunited into four groups according to gestational age: 28 to 30 weeks (G1), 31 to 33 (G2) 34 to 36 weeks (G3) and &gt;37 weeks (G4) variables analyzed were SNAP II. Results and Discussion: The receiver operating characteristic curve for SNAP-II score and death is more predictive in correlation to OD (area under curve of death is 0.776 as compared to 0.553 for OD). The sensitivity, specificity, positive predictive value, and negative predictive value of SNAP-II score with mortality (outcome) were 42.8%, 100%, 100%, and 82.3%, respectively. Conclusion: The SNAP-II revealed efficient to fantabulous ≥40 can prognosticate OD and death when applied on admission to neonates with sepsis.

Predicting Outcome in Neonates with Possible Clinical Sepsis by Estimating an Early Score for Neonatal Acute Physiology-II (SNAP-II).

To determine role of Score for Neonatal Acute Physiology-II (SNAP-II) and its individual parameters assessed within 12 h of suspicion of neonatal sepsis in predicting outcomes; study its distribution across gestational ages and determine its relation with survival duration among expired neonates. This prospective observational study conducted in a newborn unit of a tertiary care teaching hospital over 1 year included intramural neonates with birth weight ≥1000 g and gestation ≥28 weeks suspected with sepsis and assigned SNAP-II score within 12 h of suspicion. On day 14 of enrollment, they were categorized into three outcome groups: death (D), survival with organ dysfunction (SOD) and survival without organ dysfunction (SWOD). One hundred and ten neonates were enrolled and 100 analyzed. Mean SNAP-II score was 22 ± 22 (median: 13; interquartile range: 5-32.5). Seventy-six percent, 16% and 8% neonates belonged to SWOD, D and SOD groups, respectively. SNAP-II score and its individual parameters varied significantly among all outcome groups (p < 0.001). SNAP-II cutoffs of 44/115, 44/115, 38/115 and 33/115 were found to be highly predictive of D, D vs. SOD, D/SOD vs. SWOD and SWOD vs. SOD, respectively (sensitivity: 87.5-99%; specificity: 75-99%). The score was unaffected by gestational age (p = 0.80). Neonates with culture positive sepsis/meningitis had higher SNAP-II scores (p = 0.001). SNAP-II and its individual parameters found to have high sensitivity and specificity in predicting outcomes in possible neonatal sepsis and may have a role in predicting severity of disease progression and rapidity of deterioration among non-survivors, pending validation in larger studies.

Prediction of ECMO and Mortality in Neonates with Congenital Diaphragmatic Hernia Using the SNAP-II Score.

The mortality of neonates with congenital diaphragmatic hernia (CDH) ranges between 20 and 40% even in specialized high-volume centers. The Score for Neonatal Acute Physiology-II (SNAP-II Score) could facilitate the decision about supportive therapies in CDH newborns. The SNAP-II score consists of the variables arterial blood pressure, pH, PaO2:FiO2, body temperature, diuresis, and seizure activity and was calculated at an age of 12 h. 101 CDH newborns treated in our institution between 2009 and 2017 were included in the study. A SNAP-II score ≥ 28 was calculated as cutoff for predicting mortality (AUC 0.876; 95% CI: 0.795-0.957). The mortality rate was 52.9% with a SNAP-II score ≥ 28, and 5.9% with a SNAP-II score<28. Sensitivity and specificity for predicting mortality was 81.8 and 79.7%, the negative predicting value (NPV) was 94.0%, the positive predicting value (PPV) 52.9%. The optimal cutoff for predicting ECMO was ≥ 22 (AUC 0.895; 95% CI: 0.836-0.954). Sensitivity and specificity for predicting ECMO therapy was 90.7, and 63.8%, the NPV was 90.2%, and the PPV was 65% respectively. The SNAP-II score was independently associated with mortality [OR 1.126 (95% CI: 1.050-1.207)] and the need for ECMO therapy [OR 1.243 (95% CI: 1.106-1.397)]. The SNAP-II score is strongly associated with mortality and the need for ECMO therapy in CDH newborns and should be implemented in the risk stratification of these infants.

Neurodevelopmental Outcomes of Infants Born at

To compare mortality and neurodevelopmental outcomes of outborn and inborn preterm infants born at <29 weeks of gestation admitted to Canadian neonatal intensive care units (NICUs). Data were obtained from the Canadian Neonatal Network and Canadian Neonatal Follow-up Network databases for infants born at <29 weeks of gestation admitted to NICUs from April 2009 to September 2011. Rates of death, severe neurodevelopmental impairment (NDI), and overall NDI were compared between outborn and inborn infants at 18-21 months of age, corrected for prematurity. Of 2951 eligible infants, 473 (16%) were outborn. Mean birth weight (940 ± 278 g vs 897 + 237 g), rates of treatment with antenatal steroids (53.9% vs 92.9%), birth weight small for gestational age (5.3% vs 9.4%), and maternal college education (43.7% vs 53.9%) differed between outborn and inborn infants, respectively (all P values <.01). The median Score for Neonatal Acute Physiology-II (P = .01) and Apgar score at 5 minutes (P < .01) were higher in inborn infants. Severe brain injury was more common among outborn infants (25.3% vs 14.7%, P < .01). Outborn infants had higher odds of death or severe NDI (aOR 1.7, 95% CI 1.3-2.2), death or overall NDI (aOR 1.6, 95% CI 1.2-2.2), death (aOR 2.1, 95% CI 1.5-3.0), and cerebral palsy (aOR 1.9, 95% CI 1.1-3.3). The composite outcomes of death or neurodevelopmental impairment were significantly higher in outborn compared with inborn infants admitted to Canadian NICUs. Adverse outcomes were mainly attributed to increased mortality and cerebral palsy in outborn neonates.

Early postnatal illness severity scores predict neurodevelopmental impairments at 10 years of age in children born extremely preterm.

IntroductionA neonatal illness severity score, The Score for Neonatal Acute Physiology-II (SNAP-II), predicts neurodevelopmental impairments at two years of age among children born extremely preterm. We sought to evaluate to what extent SNAP-II is predictive of cognitive and other neurodevelopmental impairments at 10 years of age.MethodsIn a cohort of 874 children born before 28 weeks of gestation, we prospectively collected clinical, physiologic and laboratory data to calculate SNAP-II for each infant. When the children were 10 years old, examiners who were unaware of the child's medical history assessed neurodevelopmental outcomes, including neurocognitive, gross motor, social, and communication functions, diagnosis and treatment of seizures or attention deficit hyperactivity disorder (ADHD), academic achievement, and quality of life. We used logistic regression to adjust for potential confounders.ResultsAn undesirably high SNAP-II (≥ 30), present in 23% of participants, was associated with an increased risk of cognitive impairment (IQ, executive function, language ability), adverse neurological outcomes (epilepsy, impaired gross motor function), behavioral abnormalities (attention deficit disorder and hyperactivity), social dysfunction (autistic spectrum disorder) and education-related adversities (school achievement and need for educational supports.In analyses that adjusted for potential confounders, Z-scores ≤ -1 on 11 of 18 cognitive outcomes were associated with SNAP-II in the highest category and 6 of 18 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals ranged from 1.4 (1.01, 2.1) to 2.1 (1.4, 3.1). Similarly, 2 of the 8 social dysfunctions were associated with SNAP-II in the highest category, and 3 of 8 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals were slightly higher for these assessments, ranging from 1.6 (1.1, 2.4) to 2.3 (1.2, 4.6).ConclusionAmong very preterm newborns, physiologic derangements present in the first 12 postnatal hours are associated with dysfunctions in several neurodevelopmental domains at 10 years of age. We are unable to make inferences about causality.

Score for Neonatal Acute Physiology-II Predicts Outcome in Congenital Diaphragmatic Hernia Patients.

Accurate and validated predictors of outcome for infants with congenital diaphragmatic hernia are needed. Score for Neonatal Acute Physiology-II has been validated to predict mortality in newborns. We investigated whether Score for Neonatal Acute Physiology-II scores in congenital diaphragmatic hernia could predict mortality, need for extracorporeal membrane oxygenation (in patients born in a center with extracorporeal membrane oxygenation availability), and development of bronchopulmonary dysplasia (oxygen dependency beyond 28 d after birth) in survivors. Data were obtained from a prospective, multicenter randomized controlled trial of initial ventilation strategy carried out by the Congenital Diaphragmatic Hernia EURO Consortium (NTR 1310). ICUs of level III university children's hospitals. Congenital diaphragmatic hernia infants without severe chromosomal anomalies or severe cardiac anomalies born between November 2008 and December 2013. Randomization for initial ventilation strategy (high-frequency oscillation/ conventional mechanical ventilation. Logistic regression analyses were used to evaluate associations between Score for Neonatal Acute Physiology-II and outcome parameters. Of the 171 included patients, 46 died (26.9%), 40 of 108 (37.0%) underwent extracorporeal membrane oxygenation, and 39 of 125 survivors (31.2%) developed bronchopulmonary dysplasia. In nonsurvivors, the median Score for Neonatal Acute Physiology-II was 42.5 (interquartile range, 33.5-53.8) and 16.5 (interquartile range, 9.0-27.5) in survivors (p < 0.001). Score for Neonatal Acute Physiology-II also significantly differed between extracorporeal membrane oxygenation and non-extracorporeal membrane oxygenation-treated patients (p < 0.001), and survivors with and without bronchopulmonary dysplasia (p < 0.001). Multivariable logistic regression analyses adjusted for hernia side, liver position, ventilation mode, gestational age, center and observed-to-expected lung-to-head-ratio showed that Score for Neonatal Acute Physiology-II was associated with mortality (odds ratio, 1.16 [1.09-1.23]; p < 0.001) and need for extracorporeal membrane oxygenation support (odds ratio, 1.07 [1.02-1.13]; p = 0.01), but not for the development of bronchopulmonary dysplasia (odds ratio, 1.04 [0.99-1.09]; p = 0.14). The Score for Neonatal Acute Physiology-II predicts not only mortality but also need for extracorporeal membrane oxygenation in congenital diaphragmatic hernia patients. We, therefore, recommend to implement this simple and rapid scoring system in the evaluation of severity of illness in patients with congenital diaphragmatic hernia and thereby have insight into the prognosis within 1 day after birth.

Problems of the neonates with congenital heart disease requiring early interventions: a regional report.

In this study, it was aimed to determine the problems of the neonates who were diagnosed with congenital heart disease requiring early intervention in our hospital. The files of the newborn babies with congenital heart disease requiring early intervention who were admitted to the neonatal intensive care unit of our hospital between January 2011 and January 2013 were evaluated retrospectively. In all cases, echocardiography and ''Score for Neonatal Acute Physiology-II" (SNAP-II) scoring were performed within the first day of admission. The data were interpreted using Number Cruncher Statistical System 2007 software. The statistical significance was set at p<0.05. A total of 83 babies were included in the study. Forty six of the patients were male (55%), and 37 (45%) were female. Sixty eight percent of the patients were referred from the neighboring provinces and 32% were transferred from the centers within the city. The age range was between 0 and 28 (5.6±6.4 day) days. The SNAP-II scores upon admission ranged between 0 and 90 (mean: 20±20.3). None of the patients was diagnosed prenatally. The most common diagnoses included transposition of the great arteries (33.7%) and pulmonary atresia (19.3%). Nineteen (22%) patients were lost in the neonatal intensive care unit. There was a significant relationship between the mortality and the SNAP-II scores (p=0.0001) and use of vasopressors (p=0.004). The diagnosis, gender, use of alprostadil and age were not related to mortality. Three patients were discharged following planning of elective surgery and 60 patients were referred to a tertiary center by air ambulance. The results of our study indicated that prenatal diagnosis could not be made in neonates with congenital heart disease requiring intervention in our region. The mortality rates of these patients were related to the severity of the clinical status at presentation rather than to the age, gender and type of congenital heart disease. The mortality was much higher in the patients who developed circulatory failure. Most of the patients who survived were sent by air ambulance to the centers where the intervention was to be performed.

Lenticulostriate vasculopathy in extremely low gestational age newborns: Inter-rater variability of cranial ultrasound readings, antecedents and postnatal characteristics

Although lenticulostriate vasculopathy (LSV) was first detected on a cranial ultrasound nearly 30 years ago, its clinical implications and significance remain unknown. The objective of this study was to evaluate the inter-rater reliability of cranial ultrasound readings of LSV, and to explore relationships with potential antecedents and developmental correlates in extremely low gestational age newborns. Of the 1506 infants enrolled during the years 2002-2004, 1450 had at least one set of ultrasound scans evaluated for LSV and 939 had all three sets. To evaluate the inter-rater agreement for identifying LSV, we compared readings from two independent radiologists on days 1-4, 5-14, and on or after day 15. We then evaluated the relationships between LSV and maternal, antenatal, and postnatal characteristics. Our results showed that kappa values were 0.18, 0.33, and 0.36 on days 1-4, days 5-14, and day 15 or greater. Infants who were identified as LSV positive by two readers had higher Score for Neonatal Acute Physiology-II (an illness severity indicator), higher rates of tracheal infection and bacteremia, lower partial pressure of arterial oxygen and pH levels on 2 of the first 3 postnatal days, and they were more likely to have a lower psycho-motor development index at age 2 years. Positive agreement on the presence of LSV was low, as was the kappa value, an index of inter-rater reliability. Infants with high illness severity scores and their correlates were at increased risk of developing LSV, while those who develop LSV appear to be at increased risk of motor dysfunction.

O-097 Clinical Score To Predict Outcome In Congenital Diaphragmatic Hernia; Results Obtained From An International Multicenter Study

Background In congenital diaphragmatic hernia (CDH) reliable postnatal predictors of outcome are scarce. Score for Neonatal Acute Physiology-II (SNAP-II) (Richardson, 2001) has been validated to predict mortality in newborns. We hypothesised that higher SNAP-II scores are found in non-survivors, those who need extracorporeal membrane oxygenation (ECMO), and those who develop chronic lung disease (CLD), defined as oxygen dependency at day 28. Methods In a prospective, randomised controlled multicenter trial initiated by the Euroconsortium (VICI-trial, NTR 1310), neonates born between November 2008 and December 2013, were randomised for initial ventilation strategy (either high-frequency oscillation or conventional mechanical ventilation). Prenatal, perinatal and postnatal data including SNAP-II scores were collected. Mann-Whitney U test was used for analyses. Data were presented as n (%) and median (IQR). Results Of the 173 included patients, 46 patients (26.6%) died, 39 (22.5%) underwent ECMO, and 38 patients (29.9%) of the survivors developed CLD. Overall, the SNAP-II score was 22.5 (10 to 37). In non-survivors SNAPP-II score was 40.0 (32.0 to 54.5) and 16.5 (7.8 to 26.5) in survivors (p Conclusions In this prospective multicenter study, we showed that in CDH patients SNAP-II scores may not only be useful to predict mortality but also to identify patients who need ECMO or are at risk for development of CLD.

Score for Neonatal Acute Physiology–II and Neonatal Pain Predict Corticospinal Tract Development in Premature Newborns

Premature infants are at risk for adverse motor outcomes, including cerebral palsy and developmental coordination disorder. The purpose of this study was to examine the relationship of antenatal, perinatal, and postnatal risk factors for abnormal development of the corticospinal tract, the major voluntary motor pathway, during the neonatal period. In a prospective cohort study, 126 premature neonates (24-32 weeks' gestational age) underwent serial brain imaging near birth and at term-equivalent age. With diffusion tensor tractography, mean diffusivity and fractional anisotropy of the corticospinal tract were measured to reflect microstructural development. Generalized estimating equation models examined associations of risk factors on corticospinal tract development. The perinatal risk factor of greater early illness severity (as measured by the Score for Neonatal Acute Physiology-II [SNAP-II]) was associated with a slower rise in fractional anisotropy of the corticospinal tract (P=0.02), even after correcting for gestational age at birth and postnatal risk factors (P=0.009). Consistent with previous findings, neonatal pain adjusted for morphine and postnatal infection were also associated with a slower rise in fractional anisotropy of the corticospinal tract (P=0.03 and 0.02, respectively). Lessening illness severity in the first hours of life might offer potential to improve motor pathway development in premature newborns.

Can the Score for Neonatal Acute Physiology II (SNAPII) Predict Morbidity and Mortality in Neonates with Sepsis?

Objective: We investigated whether Score for Neonatal Acute Physiology II (SNAP II) score can predict mortality and or Organ Dysfunction (OD) in neonatal sepsis. Methods: Eighty Egyptian newborns hospitalized for neonatal sepsis were investigated through a multicenter observational prospective study to determine whether SNAP II applied in the 1st 12 hours of admission would predict mortality and or OD. Results: The median SNAP II was significantly higher in babies who died or developed OD versus those who survived and improved (P=0.003 and P=0.001 respectively). Individual parameters of the SNAP II didn’t contribute equally to the risk of death, low mean arterial blood pressure and lowest blood pH were significantly associated with OD and death (P=0.002). ROC curves for the SNAP II score ≥ 40 showed moderate predictive accuracy and 90.4% and 88.9% sensitivity for OD and death, respectively. Conclusion: SNAP II score can predict mortality and OD in neonatal sepsis.

Depressive symptoms among immigrant and Canadian born mothers of preterm infants at neonatal intensive care discharge: a cross sectional study

BackgroundMothers of preterm infants are considered at higher risk for depressive symptoms, higher than for mothers of healthy term infants. Predictors of depressive symptoms in mothers of preterm infants are not yet well established. Immigrant mothers of term infants have higher prevalence of depressive symptoms than Canadian born mothers but the relative prevalence for immigrant mothers of preterm infants is unknown. This study had two aims: (i) to investigate the prevalence of depressive symptoms in immigrant as compared to Canadian born mothers of preterm infants, and (ii) to determine what factors are associated with depressive symptoms in mothers of preterm infants.MethodsThis is a multi-site, cross sectional study of mothers whose preterm infants required hospitalization in neonatal intensive care unit (NICU). Consecutive eligible mothers (N = 291) were recruited during the week prior to their infant’s NICU discharge. Mothers completed a self-administered questionnaire booklet of validated psychosocial/cultural measures including the Center for Epidemiological Studies Depression Scale (CES-D), Parental Stressor Scale:NICU, General Functioning Subscale of the McMaster Family Assessment Device, Social Support Index, and Vancouver Index of Acculturation; and demographic characteristics questions. Infant characteristics included gestational age, birth weight, sex, singleton/multiple birth, and Score for Neonatal Acute Physiology-II.ResultsImmigrant mothers (N = 107), when compared to Canadian born mothers (N = 184), reported more depressive symptoms, poorer family functioning, less social support, and less mainstream acculturation. Hierarchical regression for a subsample of 271 mothers indicated that single parent status, high stress, poorer family functioning, and less social support were associated with increased depressive symptoms and accounted for 39% of the variance on the CES-D. Immigrant status did not contribute significantly to the final regression model.ConclusionsImmigrant mothers of preterm infants are at increased risk for depressive symptoms. For immigrant and Canadian born mothers of preterm infants hospitalized in NICU and particularly for single mothers, interventions to reduce stress and increase family functioning and social support may reduce depressive symptoms. Given the effects of depression on maternal health and functioning, such an intervention may improve child outcomes.

Assessing Outcome in Interhospital Infant Transport: The Transport Risk Index of Physiologic Stability Score at Admission

To evaluate the performance of the Transport Risk Index of Physiologic Stability (TRIPS) score at admission for early mortality prediction. The study included all consecutive outborn infants admitted to a single neonatal intensive care unit (NICU) over a 3-year period. The data collected included demographic variables, 7-day NICU mortality, and severe (≥ grade 3) intraventricular hemorrhage (IVH), TRIPS score at admission, and Score for Neonatal Acute Physiology II (SNAP-II) and SNAP-Perinatal Extension-II (SNAPPE-II) scores. A total of 175 neonates were enrolled. TRIPS at admission discriminated 7-day mortality from survival with a receiver operating characteristic (ROC) area of 0.80, and predictive performance of TRIPS for severe IVH showed a ROC area of 0.67. The TRIPS had good calibration for all strata (p = 0.49). For gestational age (GA) >32 weeks, the area under the curve (AUC) for TRIPS was 0.71, whereas the AUC for GA ≤32 weeks was 0.99 for 7-day mortality. Predictive performance of TRIPS for 7-day mortality was similar to that of SNAP-II and SNAPPE-II. TRIPS score at admission had a good performance to discriminate high-risk patients for 7-day mortality, mainly infants with GA ≤32 weeks. TRIPS might be a useful triage tool if applied at the time of first contact with a transport service.