The use of the score for neonatal acute physiology-perinatal extension (SNAPPE II) in perforated necrotizing enterocolitis: could it guide therapy in newborns less than 1500 g?
BACKGROUND
Only a handful of clinical parameters other than body weight are used in managing LBW newborns with perforated necrotizing enterocolitis (NEC). Here, we determined clinical use of score for neonatal acute physiology-perinatal extension (SNAPPE II) score in the surgical decision, peritoneal drain (PD) vs PD + laparotomy in low birth weight (LBW) newborns with perforated NEC.


METHODS
A retrospective study of all neonates weighing less than 1500 g with the diagnosis of perforated NEC between 2000 and 2006 was performed. Patients were categorized in 2 groups--PD alone vs PD + laparotomy. The SNAPPE score was calculated at various days of clinical evolution. The primary outcome of mortality was used, and comparisons using univariate and multivariate analyses were performed.


RESULTS
Of 39 patients identified, 20 were treated with PD alone, whereas 19 had PD and laparotomy. The mean gestational age (25.6 vs 26.6 weeks) and the mean birth weight (795 vs 910 g) were comparable (P > .05). There were no differences between PD group and LAP group with regard to SNAPPE scores calculated on the day of admission (P = .057), the day before the drain insertion (P = .167) and the day after the drain insertion (P = .66). When considering survival as the dependent variable while controlling for the treatment assignment, the modified SNAPPE score after PD drain insertion in group PD was significantly higher than in the PD + laparotomy group (21.4 vs 9.47; P = .009).


CONCLUSIONS
The modified SNAPPE score is a good predictor of mortality after the PD insertion. A post-PD insertion, high SNAPPE value was correlated with increased mortality regardless of an additional laparotomy. External validation of the modified SNAPPE score in a large patient population is required before its use in guiding treatment decisions.
Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
Arnaud
A
Bonnard
Mohammed
M
Zamakhshary
Sigmund
S
Ein
Asdeen
A
Moore
Peter C W
PC
Kim
D000208:Acute Disease; D000704:Analysis of Variance; D015331:Cohort Studies; D004322:Drainage / Q000379:methods / Q000592:standards; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D007813:Laparotomy / Q000379:methods / Q000592:standards; D008297:Male; D015999:Multivariate Analysis; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome