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Eur J Pediatr Surg 2016; 26(04): 316-321
DOI: 10.1055/s-0035-1554103
Original Article
Georg Thieme Verlag KG Stuttgart · New York

SNAPPE II Score As a Predictor of Survival in Neonates with Congenital Diaphragmatic Hernia: A Single Center Experience

Louisa W. Chiu
1   Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, Michigan, United States
2   Department of Surgery, Baylor College of Medicine, Houston, Texas, United States
,
Jagdish Desai
3   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan, United States
,
Christina Shanti
1   Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, Michigan, United States
,
Sharayu Rane
3   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan, United States
,
Prashant Agarwal
3   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan, United States
,
Ronald Lee Thomas
4   Department of Biostatistics, Children's Research Center of Michigan, Wayne State University, Detroit, Michigan, United States
,
Michael Klein
1   Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, Michigan, United States
,
Nitin Shashikant Chouthai
3   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan, United States
› Author Affiliations
Further Information

Publication History

06 February 2015

31 March 2015

Publication Date:
12 August 2015 (online)

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Abstract

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.

Keywords

congenital diaphragmatic hernia - predictors of mortality - SNAPPE II score
 

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