Score for neonatal acute physiology II predicts mortality and persistent organ dysfunction in neonates with severe septicemia.

OBJECTIVE: To investigate the relationship between score for neonatal acute physiology II (SNAP II) applied within 12 hours from the onset of severe sepsis, and death and persistent organ dysfunction (OD). DESIGN: Prospective cohort study. SETTING: Level III neonatal intensive care unit. PARTICIPANTS: Neonates with severe sepsis. INTERVENTION: SNAP II was applied within the first 12 hours from the onset of severe sepsis. Neonates with major malformations, severe asphyxia and prior blood products were excluded. MAJOR OUTCOME MEASURE: Death at day 14 from enrolment. RESULTS: Forty neonates completed the study. Twenty-five died within 14 days. The median SNAP II was significantly higher in babies who died versus those who survived [median (IQR): 43 (36-53.5) vs 18 (16-37), P<0.001]. A SNAP II greater than 40 had 88% positive predictive value for death and persistent OD each, and 86.6% and 86% specificity for death and persistent OD, respectively. On day 14 from enrolment, more organs normalized/improved in the subjects with SNAP II of < or = 40. Perfusion related SNAP II parameters were significantly associated with death and organ dysfunction. CONCLUSIONS: Severely septicemic neonates with high SNAP II scores (>40) have a higher risk of dying and persistent organ dysfunction. Individual SNAP II parameters do not contribute equally in prediction of mortality.