Can severity-of-illness indices for neonatal intensive care predict outcome at 4 years of age?
OBJECTIVE
To test four neonatal severity-of-illness indices (CRIB, NTISS, SNAP, SNAP-PE) for their ability to predict short- and long-term outcome in very low-birthweight infants receiving neonatal intensive care.


METHODS
Data on 240 newborns with birthweights below 1500 g from two Swedish neonatal units were collected. The predictive values of the indices for an adverse outcome in the neonatal period and at 4 y of age were compared with those of gestational age and birthweight.


RESULTS
An early adverse outcome (in-hospital death, severe haemorrhagic-ischaemic brain lesion, retinopathy, chronic lung disease) was better predicted with CRIB (area under ROC curve (Az) = 0.87) and SNAP-PE (Az = 0.86), while SNAP-PE was best for predicting late problems (deviations in growth and psychomotor development, neurosensory impairment, difficulties in concentration, and impairment in vision, and hearing) (Az = 0.63). All indices predicted the early outcome better than the outcome at the 4-y follow-up. Severity-of-illness indices can be used as instruments to follow and improve the level of neonatal intensive care, but unfortunately seem to be of little value in long-term follow-up.


CONCLUSIONS
CRIB and SNAP-PE indices are better in predicting hospital mortality than birthweight. None of the systems can predict adverse outcome at 4 y of age.
Eriksson
M
M
Department of Paediatrics, Orebro University Hospital, Sweden. mats.eriksson@orebroll.se
Bodin
L
L
Finnström
O
O
Schollin
J
J
D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology; D006304:Health Status; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D015233:Models, Statistical; D015997:Neonatal Screening; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index