Department of Pediatrics, School of Medicine, Iwate Medical University, Iwate, Japan.
J Matern Fetal Neonatal Med. 2022 Mar;35(5):846-851. doi: 10.1080/14767058.2020.1731794. Epub 2020 Feb 25.
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.
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.
The overall mortality rate was 11.1%. Mortality at 23 weeks' gestation was higher than that at 24-27 weeks' gestation ( < .01, adjusted residual 4.5). Neonatal illness severity scores were significantly higher in infants who died than in those who survived ( < .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.
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.
新生儿疾病严重程度评分对极早产儿病死率或发病率的预测能力尚未得到广泛研究。我们旨在评估新生儿疾病严重程度评分[婴儿临床风险指数 II（CRIB II）、新生儿急性生理学评分 II（SNAP-II）和新生儿围生期扩展 II（SNAPPE-II）]预测极早产儿病死率和短期发病率的能力。
本回顾性研究纳入了 2010 年至 2017 年期间入住新生儿重症监护病房（NICU）、胎龄为 22 至 27 周的 171 例婴儿。通过比较受试者工作特征曲线下面积来评估新生儿疾病严重程度评分对病死率和短期发病率（支气管肺发育不良、早产儿视网膜病变、颅内出血、坏死性小肠结肠炎和胃肠道穿孔）的预测能力。
总病死率为 11.1%。23 周胎龄的病死率高于 24 至 27 周胎龄（<0.01，校正残差 4.5）。死亡组婴儿的新生儿疾病严重程度评分显著高于存活组（<0.01）。CRIB II（AUC 0.93，95%CI 0.85-1.00）、SNAP-II（AUC 0.90，95%CI 0.76-1.00）和 SNAPPE-II（AUC 0.95，95%CI 0.91-0.99）似乎是极好的预测指标，优于出生体重（AUC 0.88，95%CI 0.80-0.95）或胎龄（AUC 0.84，95%CI 0.72-0.96）单独预测早期死亡（出生后<28 天死亡）。CRIB II、SNAP-II 和 SNAPPE-II 预测极早产儿早期死亡的能力优于病死率。新生儿疾病严重程度评分与短期发病率无明显相关性。
新生儿疾病严重程度评分是极早产儿早期死亡的极好预测指标，可能有助于选择需要干预的极早产儿。
