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Comparison of CRIB-II with SNAPPE-II for predicting survival and morbidities before hospital discharge in neonates with gestation ≤ 32 weeks: a prospective multicentric observational study

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Abstract

Various studies validated and compared Score for Neonatal Acute Physiology with Perinatal extension-II (SNAPPE-II) and Clinical Risk Index for Babies-II (CRIB-II) admission sickness severity scores for predicting survival, but very few studies compared them for predicting the morbidities in preterm infants. In this multicenter prospective observational study, SNAPPE-II and CRIB-II newborn illness severity scores were compared for predicting mortality and morbidities in infants with gestational age of ≤ 32 weeks. Major morbidities were classified as bronchopulmonary dysplasia, abnormal cranial ultrasound (presence of intraventricular hemorrhage grade III or more or periventricular leukomalacia grade II to IV), and retinopathy of prematurity requiring treatment. Combined adverse outcome was defined as death or any major morbidity. Comparison of the scoring systems was done by area under the curve (AUC) on receiver operating characteristics curve (ROC curve) analysis. A total of 419 neonates who were admitted to 5 participating NICUs were studied. The mortality rate in the study population was 8.8%. Both CRIB-II (AUC: 0.795) and SNAPPE-II (AUC: 0.78) had good predictive ability for in-hospital mortality. For predicting any one of the major morbidities and combined adverse outcome, CRIB-II had better predictive ability than SNAPPE-II with AUC of 0.83 vs. 0.70 and 0.85 vs. 0.74, respectively.

Conclusion: In infants with gestational age of ≤ 32 weeks, both CRIB-II and SNAPPE-II are good scoring systems for predicting mortality. CRIB-II, being a simpler scoring system and having better predictive ability for major morbidities and combined adverse outcome, is preferable over SNAPPE-II.

What is Known:

• SNAPPE-II and CRIB-II scores have good predictive ability on in-hospital mortality in preterm neonates.

What is New:

• SNAPPE-II and CRIB-II both have good predictive ability for mortality, but CRIB-II has better ability for short-term morbidities related to the prematurity.

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Data will be available with corresponding author.

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Abbreviations

AUC:

Area under the curve

BPD:

Bronchopulmonary dysplasia

CI:

Confidence interval

CRIB-II:

Clinical Risk Index for Babies-II

CUS:

Cranial ultrasound

d.f.:

Degrees of freedom

FiO2 :

Fraction of inspired oxygen

HL test:

Hosmer-Lemeshow test

INNC:

Indian National Neonatal Collaborative

IVH:

Intraventricular hemorrhage

NEC:

Necrotizing enterocolitis

NPV:

Negative predictive value

NICU:

Neonatal intensive care unit

OR:

Odds ratio

PaO2:

Partial pressure of oxygen in arterial blood

PPV:

Positive predictive value

PVL:

Periventricular leukomalacia

ROC curve:

Receiver operating characteristics curve

ROP:

Retinopathy of prematurity

SD:

Standard deviation

SGA:

Small for gestational age

SNAP:

Score for Neonatal Acute Physiology

SNAPPE-II:

Score for Neonatal Acute Physiology with Perinatal extension-II

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Authors and Affiliations

  1. Dept of Neonatology, Fernandez Hospital, Hyderabad, Telangana, India

    Venkateshwarlu Vardhelli, Srinivas Murki, Tejo Pratap Oleti & Saikiran Deshabhotla

  2. Dept of Neonatology, Vijay Marie Hospital, Hyderabad, Telangana, India

    Baswaraj Tandur & Yassar Arafat Mohammed

  3. Dept of Neonatology, SSKM Hospital, Kolkata, West Bengal, India

    Bijan Saha & Soutrik Seth

  4. Dept of Neonatology, Princess Durru Shehvar Hospital, Hyderabad, Telangana, India

    Sunayana Siramshetty

  5. Dept of Neonatology, Paramitha Hospital, Hyderabad, Telangana, India

    Venkat Reddy Kallem

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  1. Venkateshwarlu Vardhelli
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Contributions

Concept of the study: VV, SM, VK; design of study: VV, SM, TO, BS, BT; data acquisition: VV, BT, BS, YM, SS, SSS, VK; analysis: VV, SM, SD; drafting of the work and revising the manuscript: VV, SM, SD, TO. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

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Correspondence to Venkateshwarlu Vardhelli.

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Statement of ethics

Institutional review board approval (Fernandez Hospital Ethics Committee. Ref. No: 03_2018) was obtained.

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Written informed consent was provided by all parents.

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The authors declare no competing interests.

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Communicated by Daniele De Luca

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Vardhelli, V., Murki, S., Tandur, B. et al. Comparison of CRIB-II with SNAPPE-II for predicting survival and morbidities before hospital discharge in neonates with gestation ≤ 32 weeks: a prospective multicentric observational study. Eur J Pediatr 181, 2831–2838 (2022). https://doi.org/10.1007/s00431-022-04463-2

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