Prediction of ECMO and Mortality in Neonates with Congenital Diaphragmatic Hernia Using the SNAP-II Score

Abstract

Background The mortality of neonates with congenital diaphragmatic hernia (CDH) ranges between 20 and 40% even in specialized high-volume centers. The Score for Neonatal Acute Physiology-II (SNAP-II Score) could facilitate the decision about supportive therapies in CDH newborns.

Methods The SNAP-II score consists of the variables arterial blood pressure, pH, PaO₂:FiO₂, body temperature, diuresis, and seizure activity and was calculated at an age of 12 h.

Results 101 CDH newborns treated in our institution between 2009 and 2017 were included in the study. A SNAP-II score ≥ 28 was calculated as cutoff for predicting mortality (AUC 0.876; 95% CI: 0.795–0.957). The mortality rate was 52.9% with a SNAP-II score ≥ 28, and 5.9% with a SNAP-II score<28. Sensitivity and specificity for predicting mortality was 81.8 and 79.7%, the negative predicting value (NPV) was 94.0%, the positive predicting value (PPV) 52.9%. The optimal cutoff for predicting ECMO was ≥ 22 (AUC 0.895; 95% CI: 0.836–0.954). Sensitivity and specificity for predicting ECMO therapy was 90.7, and 63.8%, the NPV was 90.2%, and the PPV was 65% respectively. The SNAP-II score was independently associated with mortality [OR 1.126 (95% CI: 1.050–1.207)] and the need for ECMO therapy [OR 1.243 (95% CI: 1.106–1.397)].

Conclusion The SNAP-II score is strongly associated with mortality and the need for ECMO therapy in CDH newborns and should be implemented in the risk stratification of these infants.

Zusammenfassung

Hintergrund Die angeborene Zwerchfellhernie (CDH) gehört mit einer Mortalität von 20–35% zu den schwerwiegendsten Fehlbildungen bei Neugeborenen. Der „Score for Neonatal Acute Physiology-II (SNAP-II Score)“ könnte bei Neonaten mit CDH helfen eine Entscheidung über weiterführende Therapien zu treffen.

Methode Der SNAP-II Score umfasst die Variablen Blutdruck, Temperatur, PaO2:FiO2, pH, Diurese und Vorhandensein zerebraler Anfallsaktivität. Der SNAP-II Score wurde im Alter von 12 Std. berechnet.

Ergebnisse Eingeschlossen wurden 101 Neonaten mit CDH, die zwischen 2009 und 2017 in unserer Klinik behandelt wurden. Die Mortalität betrug 21,8, 39,6% erhielten eine ECMO-Therapie. Bzgl. Der Prädiktion Mortalität wurde ein Grenzwert von 28 berechnet (AUC 0,876; 95% CI: 0,795–0,957). Die Mortalität lag bei einem SNAP-II score ≥ 28 bei 52,9% und bei einem Score<28 bei 5,9%. Sensitivität und Spezifität betrugen 94,4 bzw. 83,6%, der positive prädiktive Wert (PPV) 63% und der negative prädiktive Wert (NPV) 98,1%. Der Grenzwert zur Prädiktion einer ECMO-Therapie war 22 (AUC 0,895; 95% CI: 0,836–0,954). Die ECMO-Rate für einen SNAP-II score ≥ 22 war 65 bzw. 9,8% bei<22. Sensitivität und Spezifität 82,1 bzw. 68,6%, PPV 59%, NPV 87,5%. Der SNAP-II score war unabhängig mit dem Versterben [OR 1,126 (95% CI: 1,050–1,207)] und der Notwendigkeit einer ECMO-Therapie [OR 1,243 (95% CI: 1,106–1,397)] assoziiert.

Schlussfolgerung Mittels SNAP-II Score im Alter von 12 Stunden lässt sich eine suffiziente prognostische Einschätzung bei CDH-Neugeborenen durchführen.

Key words

congenital diaphragmatic hernia - SNAP-II score - risk stratification - extracorporeal membrane oxygenation - mortality

Schlüsselwörter

Angeborene Zwerchfellhernie - SNAP-II Score - Risikostratifizierung - Extrakorporale Membranoxygenierung - Mortalitat

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