CAN CRIB AND SNAP SCORES BE APPLIED TO SURGICAL NEONATES?

Objective: The aim of our study was to determine if the well established neonatal illness severity scores CRIB(Clinical Risk Index for Babies) and SNAP(Score for Neonatal Acute Physiology) are also applicable to surgical neonates, and if these scores carry a meaningful predictive value. Methods: The records of all neonates with life threatening surgical anomalies (criteria according to Levi S. Ann N.Y. Ac. Sci.: 847:86-98,1997) admitted to our unit from January 1998 to January 1999, were reviewed. CRIB and SNAP scores were applied and the correlations with prolonged hospital stay ([is greater than] 1month) and mortality rate were sought. Statistical analysis was performed by Receiving Operating Characteristics(ROC) curves: predictive values were expressed as the areas under the curves. Area values [is less than] 0,5 were not predictive. Results: 96 neonates were evaluated: ROC curves were generated for each of the considered parameters. There was a statistically significant correlation for both scores regarding mortality (p [is less than] .00001; 95% CI:CRIB 0.63-0,90,SNAP 0.65-0.90), with an area under curve(Az) of 0.77 for CRIB and 0.78 for SNAP; however only SNAP was significant(p [is less than] .0001; 95% CI 0.88-0.96)regarding hospital stay, with an Az of 0,63 for CRIB and 0,93 for SNAP. Conclusions: SNAP was as significant for surgical newborns as it was for non-surgical intensive care neonates regarding mortality and hospital stay allowing appropriate resource allocation and cost containment. CRIB was not as useful in predicting prolonged hospital stay. New scores are needed to address outcome predictions of surgical neonates.
C. Gatti, R. Pariante(*), V. Pardi, A. Trucchi, A. Nahom, A. Dotta(*), A. Zaccara, R. Laviani(*), P Bagolan, M. Orzalesi(*) and M.W.L. Gauderer , MD, FAAP; Neonatal Surgery and Intensive [...]