Reshami gives birth on a health clinic in a mountain area of Nepal. Her daughter Mayanna is born in the light from a candle, and attended by a trained health worker. This gives Mayanna a better start on her life, and enhances the chances for her survival. The picture is not to be sold or given away oustide SC. The health stations are run by a women's network that is keeping more and more women and children alive in Nepal. SC is central in the work to lower child mortality in Nepal. The picture can not be sold or given away outside SC. *** Local Caption *** Reshami føder sitt andre barn på en helseklinikk i et fjellområde i Nepal. Datteren Mayanna er født i lyset fra et stearinlys, og med en utdannet helsearbeider til stede. Dette øker sterkt sjansen for at Mayanna skal overleve sitt første leveår. Bildet kan ikek gis bort eller selges utenfor SC. Stadig flere kvinner og barn blir holdt i live av helseklinikkene i Nepal. Bidlet kan ikke gis bort eller selges utenfor SC.
Background
There are many scoring systems to predict neonatal mortality and morbidity in neonatal intensive care units (NICU). One of the scoring systems is SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal extension-II). This study was carried out to assess the validity of SNAPPE-II score (Score for Neonatal Acute Physiology with Perinatal Extension-II) as a predictor of neonatal mortality and duration of stay in a neonatal intensive care unit (NICU).
Methods
This prospective, observational study was carried out over a period of 12 months from June 2015 to May 2016. Two hundred fifty five neonates, who met the inclusion criteria admitted to NICU in tertiary care hospital, BPKIHS Hospital, Nepal were enrolled in the study and SNAPPE-II score was calculated. Receiver Operating Characteristic (ROC) curve was constructed to derive the best SNAPPE-II cut-off score for mortality.
Results
A total of 305 neonates were admitted to NICU over a period of one year. Among them, 255 neonates fulfilled the inclusion criteria. Out of 255 neonates, 45 neonates (17.6%) died and 210 were discharged. SNAPPE-II score was significantly higher among neonates who died compared to those who survived [median (IQR) 57 (42–64) vs. 22 (14–32), P < 0.001]. SNAPPE II score had discrimination to predict mortality with area under ROC Curve (AUC): 0.917 (95% CI, 0.854–0.980). The best cut – off score for predicting mortality was 38 with sensitivity 84.4%, specificity 91%, positive predictive value 66.7% and negative predictive value 96.5%. SNAPPE II score could not predict the duration of NICU stay (P = 0.477).
Conclusion
SNAPPE- II is a useful tool to predict neonatal mortality in NICU. The score of 38 may be associated with higher mortality.