The present study documented that the SNAPPE II score of the neonates who died in the NICU was higher than in those who survived. The higher the score of SNAPPE- II, the higher was the mortality risk of neonates. SNAPPE II score of ≥38 was the best to predict mortality with sensitivity 84.4%, specificity 91%, positive predictive value (PPV) 66.7% and negative predictive value (NPV) of 96.5%. There was no significant correlation between SNAPPE II score and duration of NICU stay.
This result supports the study done by original author Richardson et al. (AUC 0.91) [
10], Zupanic et al. (AUC 0.90) [
11] and Mia et al. [
12] in Soetomo Hospital, Indonesia in which AUC was 0.863. In studies conducted in a tertiary care hospital, Indonesia [
12] (score of ≥40), in a general pediatric hospital in Paraguay [
13] (score of ≥40), Niranjan et al. in India [
14] (score of ≥37) & in Indira Gandhi Institute of Child Health, India [
15] (score of ≥37) were all associated with higher mortality which is similar to our results. But in contrast to our results, studies conducted in a hospital of indonesia [
16] (with a score of ≥51), by Ucar et al. [
17], (score of ≥33), Dammann et al. [
18], (a score of ≥30) were associated with high mortality. In two studies done in India by Niranjan et al. [
14] and (Harsha & Archana) [
15] with cut-off score of ≥37 in both studies, Sensitivity (84.4% vs. 76.1% & 76.9%), specificity (91% vs. 87.1% & 87.9%) and NPV (96.5% vs. 52.6%) were higher in our study than these two studies. But positive predictive value in our study was less (66.7 vs. 95. 3%). Variation in the cut-off score and discrimination might be due to the factors affecting the score such as diseases, severity of illness, quality of care in NICU etc. There was no significant correlation between SNAPPE II score and duration of NICU stay (
P = 0.477). But SNAPPE II score had positive correlation with duration of NICU stay as correlation coefficient was r = 0.045 which is similar to a study done by Harsha & Archana [
15] in India where
P = 0.255 for duration of NICU stay. Other studies also reported similar findings [
19,
20].
All newborns who were born at home and those neonates who left NICU against medical advice were excluded from the study. Birth-weight and Apgar score of outborn neonates were taken from referral card. These were the limitations of this study.
Thus, SNAPPE II score is a useful tool to asess the severity of illness and prognosis. These findings can be implicated in NICU routinely to know the most critical newborn for prioritizing the management and for the purpose of counselling the parents. This score might also be used to compare the effectiveness of various NICU across the country which will help to improve the facilities provided by different NICUs.