Revalidation of the Score for Neonatal Acute Physiology in the Vermont Oxford Network.
OBJECTIVE
Our specific objectives were (1) to document the performance of the revised Score for Neonatal Acute Physiology and the revised Score for Neonatal Acute Physiology Perinatal Extension in predicting death in the Vermont Oxford Network, compared with published normative values; (2) to determine whether this performance could be improved through recalibration of the weights for individual score items; (3) to determine the impact of including congenital anomalies in the predictive model; and (4) to compare performance against that of the Vermont Oxford Network risk adjustment, separately and in combination.


METHODS
Fifty-eight Vermont Oxford Network centers collected data prospectively for the revised Score for Neonatal Acute Physiology in the first 12 hours after admission of infants in 2002.


RESULTS
Data were collected for 10,469 infants, and analyses were undertaken for 9897 who met inclusion criteria. The median revised Score for Neonatal Acute Physiology was 5, and the mean birth weight was 1951 g. Recalibration of the revised Score for Neonatal Acute Physiology and revised Score for Neonatal Acute Physiology Perinatal Extension resulted in minimal changes in their discriminatory abilities. The Vermont Oxford Network risk adjustment performed similarly, compared with the revised Score for Neonatal Acute Physiology Perinatal Extension.


CONCLUSIONS
Current score performance was similar to that observed previously, which suggests that the revised Score for Neonatal Acute Physiology and revised Score for Neonatal Acute Physiology Perinatal Extension have not decalibrated over the 7 years since the first cohort was assembled, despite advances in neonatal care during that period. Addition of congenital anomalies to the revised Score for Neonatal Acute Physiology Perinatal Extension improved discrimination significantly, particularly for infants with birth weights of >1500 g. The Vermont Oxford Network risk adjustment performed similarly, compared with the revised Score for Neonatal Acute Physiology Perinatal Extension.
Zupancic
John A F
JA
Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Rose Building, Room 318, Boston, MA 02215, USA. jzupanci@bidmc.harvard.edu
Richardson
Douglas K
DK
Horbar
Jeffrey D
JD
Carpenter
Joseph H
JH
Lee
Shoo K
SK
Escobar
Gabriel J
GJ
D001034:Apgar Score; D001724:Birth Weight; D000013:Congenital Abnormalities / Q000401:mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index