Mesquita Ramirez Mirta Noemi, Godoy Laura Evangelina, Alvarez Barrientos Elizabeth
Hospital General Pediátrico "Niños de Acosta Ñú", Avenida de la Victoria and Bacigalupo, Reducto, 2160 San Lorenzo, Paraguay.
Int J Pediatr. 2014;2014:298198. doi: 10.1155/2014/298198. Epub 2014 Feb 26.
Introduction. In developing countries, a lack of decentralization of perinatal care leads to many high-risk births occurring in facilities that do not have NICU, leading to admission to a PICU. Objective. To assess SNAP II and SNAPPE II as predictors of neonatal death in the PICU. Methodology. A prospective study of newborns divided into 3 groups according to postnatal age: Group 1 (G1), of 0 to 6 days; Group 2 (G2) of 7 to 14 days; and Group 3 (G3), of 15 to 28 days. Variables analyzed were SNAP II, SNAPPE II, perinatal data, and known risk factors for death. The Hosmer-Lemeshow test and the receiver operating characteristics (ROC) curve were used with SPSS 17.0 for statistical analysis. An Alpha error <5% was considered significant. Results. We analyzed 290 newborns, including 192 from G1, 41 from G2, and 57 from G3. Mortality was similar in all 3 groups. Median SNAP II was higher in newborns that died in all 3 groups (P < 0.05). The area under the ROC curve for SNAP II for G1 was 0.78 (CI 95% 0.70-0.86), for G2 0.66 (CI 95% 0.37-0.94), and for G3 0.74 (CI 95% 0.53-0.93). The area under the ROC curve for SNAPPE II for G1 was 0.76 (CI 95% 0.67-0.85), for G2 0.60 (CI 95% 0.30-0.90), and for G3 0.74 (CI 95% 0.52-0.95). Conclusions. SNAP II and SNAPPE II showed moderate discrimination in predicting mortality. The results are not strong enough to establish the correlation between the score and the risk of mortality.
引言。在发展中国家，围产期护理缺乏分权导致许多高危分娩发生在没有新生儿重症监护病房（NICU）的机构，从而导致新生儿转入儿科重症监护病房（PICU）。目的。评估SNAP II和SNAPPE II作为PICU新生儿死亡预测指标的价值。方法。对新生儿进行前瞻性研究，根据出生后年龄分为3组：第1组（G1），出生0至6天；第2组（G2），出生7至14天；第3组（G3），出生15至28天。分析的变量包括SNAP II、SNAPPE II、围产期数据以及已知的死亡风险因素。使用SPSS 17.0软件进行Hosmer-Lemeshow检验和受试者工作特征（ROC）曲线分析，以进行统计分析。α错误<5%被认为具有统计学意义。结果。我们分析了290例新生儿，其中G1组192例，G2组41例，G3组57例。三组的死亡率相似。在所有三组中，死亡新生儿的SNAP II中位数较高（P<0.05）。G1组SNAP II的ROC曲线下面积为0.78（95%置信区间0.70-0.86），G2组为0.66（95%置信区间0.37-0.94），G3组为0.74（95%置信区间0.53-0.93）。G1组SNAPPE II的ROC曲线下面积为0.76（95%置信区间0.67-0.85），G2组为0.60（95%置信区间0.30-0.90），G3组为0.74（95%置信区间0.52-0.95）。结论。SNAP II和SNAPPE II在预测死亡率方面显示出中等的辨别能力。结果不足以确定评分与死亡风险之间的相关性。
