Home            Past Issues            About IP            About IAP           Author Information            Subscription            Advertisement              Search  

   
correspondence

Indian Pediatr 2010;47: 366-367

Score for Neonatal Acute Physiology II


We read with interest the article by Sundaram, et al.(1). One of the main objective of this paper was to evaluate the ability of SNAP score II for the prediction of death in septicemic neonates. In the study subjects, the mortality was 62.5% (25 of the 40 enrolled subjects died). What clinical use would be any predictive score when the population itself is at such a high risk of mortality? As in the study, by applying the SNAP II score the predictive ability went up by 15.5% (i.e. from baseline 62.5% to 88%). How will a patient benefit if the clinician says the risk of death is 2/3rd or 3/4th.

Srinivas Murki and Ashish Jaiswal

Fernandez Hospital,

Bogulkunta, Hyderabad, India.

Email: [email protected]

Reference

1. Sundaram V, Dutta S, Ahluwalia J, Narang A. Score for neonatal acute physiology II predeicts mortality and persistent organ dysfunction in neonates with severe septicemia. Indain Pediatr 2009; 46: 775-780.
 


In a recent article(1), the authors have cited their own primary study(2) as reference no 6, on "adapted criteria" for organ dysfunction adapted from article in reference no 10. I retrieved reference no 6(2) but could not find any adaptation criteria. Secondly, it is known that among low birth weight (LBW) babies , small for gestational age (SGA) babies have differing hormonal responses to stress(3) which can affect physiological response in return. In this study, 30% of enrolled babies were SGA. I wonder as to what was the impact of SGA status on SNAP II scores?

Baljeet Maini,

MMIMSR, Mullana,

Ambala 133 203, Haryana,India.

Email: [email protected]

References

1. Sundaram V, Dutta S, Ahluwalia J, Narang A. Score for neonatal acute physiology II predicts mortality and persistent organ dysfunction in neonates with severe septicemia. Indian Pediatr 2009; 46: 775-780.

2. Venkataseshan S, Dutta S, Ahluwalia J, Narang A. Low plasma protein C values predict mortality in low birth weight neonates with septicemia. Pediatr Infect Dis J 2007; 26: 684-688.
 


Reply

We thank Murki S, et al. and Maini B for showing interest in our article and for their comments.

Firstly, the high baseline risk of death (62.5%) observed in our study is due to the inclusion of relatively more sick neonates due to stringent inclusion criteria. However we felt it was prudent to test a clinical tool that can improve the predictive ability further to prognosticate and triage the clinical care in severely sick neonates. The negative likelihood ratio (LR-) was 0.47 making a posttest probability of dying equal to 43% if the SNAP II score is below 40. This amounts to an absolute decline of 20% from the baseline risk. If, on the basis of a relatively simple tool like SNAP II, the risk categorization can be separated into 88% versus 43%, the information is valuable both for the clinician as well as the patient.

In response to the comments from Maini B, the criteria for organ dysfunction were adapted by us from Barton P, et al.(1) and were used in the primary study(2). It was not published but only cross referred in our primary study due to limitation of space. SGA is a potent perinatal variable that can modify the risk of mortality independent of the other physiologic derangements. SNAP-perinatal extension II is an admission score derived by the addition of SGA and two other independent perinatal variables with SNAP II to enable prediction of risk of mortality(3). However, we could not use SNAPPE II for the obvious reason of it being an admission score. To the best of our knowledge, no literature is available as of now that has specifically analyzed the effect of SGA status on the performance of SNAP II.

Venkataseshan Sundaram and Sourabh Dutta,

Email: [email protected]

References

1. Barton P, Kalil AC, Nadel S, Goldstein B, Okhuysen-Cawley R, Brilli RJ, et al. Safety, Pharmacokinetics, and pharmacodynamics of drotrecogin alfa (activated) in children with severe septicemia. Pediatrics 2004; 113: 7-17.

2. Venkataseshan S, Dutta S, Ahluwalia J, Narang A. Low plasma protein C values predict mortality in low birth weight neonates with septicemia. Pediatr Infect Dis J 2007; 26: 684-688.

3. Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP II and SNAPPE II: Simplified newborn illness severity and mortality risk scores, for the Canadian NICU network, The Kaiser Permanente Neonatal minimum data set wide area network, and the SNAP II study group. J Pediatr 2001; 138: 92-100.
 

 

Copyright© 1999 by the Indian Pediatrics (Disclaimer)