SNAPPE II Score As a Predictor of Survival in Neonates with Congenital Diaphragmatic Hernia: A Single Center Experience.
Introduction Prediction of mortality and morbidity in newborns with congenital diaphragmatic hernia (CDH) is too complex for practical use and may not be accurate. The main objective of this study was to evaluate the usefulness of the CDH Study Group equation and Score of Neonatal Acute Physiology Perinatal Extension (SNAPPE) II score to predict short-term outcomes of newborns with CDH. Materials and Methods Fifty-two neonates were admitted with CDH at Children's Hospital of Michigan from November 2001 to July 2009. Retrospective chart analysis was performed. Predicted survival rates were calculated using the equation published by the CDH Study Group in 2001. SNAPPE II scores were also obtained within 12 hours of admission. Statistical analysis was performed using SPSS statistical package. Results Thirty out of 52 (58%) neonates survived to discharge. SNAPPE II score was significantly lower (p < 0.0001) in survivors (20 ± 15) versus nonsurvivors (41 ± 16). When neonates were stratified according to the CDH Study Group, low-risk patients had a survival rate of 68% (predicted 84%), moderate-risk patients had a survival rate of 43% (predicted 57%), and high-risk patients had a survival rate of 33% (predicted 36%). A total of 83% of the newborns who survived were operated within 48 hours of life, while only 17% of the nonsurvivors were operated within 48 hours of life. Conclusion SNAPPE II scores were better predictors of mortality than the CDH Study Group equation published in 2001. Further exploration is warranted to evaluate validity of survival advantage for those who were operated within 48 hours of life. A future study of combination of prenatal and postnatal factors may help in improved outcomes of the newborns with CDH.
Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, Michigan, United States.
Louisa W
LW
Chiu
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan, United States.
Jagdish
J
Desai
Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, Michigan, United States.
Christina
C
Shanti
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan, United States.
Sharayu
S
Rane
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan, United States.
Prashant
P
Agarwal
Department of Biostatistics, Children's Research Center of Michigan, Wayne State University, Detroit, Michigan, United States.
Ronald Lee
RL
Thomas
Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, Michigan, United States.
Michael
M
Klein
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan, United States.
Nitin Shashikant
NS
Chouthai
D015897:Comorbidity; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008824:Michigan / Q000453:epidemiology; D015997:Neonatal Screening / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate