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  • Original Article
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SNAP-II Predicts Mortality among Infants with Congenital Diaphragmatic Hernia

Journal of Perinatology volume 25, pages 315–319 (2005)Cite this article

Abstract

OBJECTIVE:

Outcomes analysis in congenital diaphragmatic hernia (CDH) requires a validated risk-adjustment tool. The purpose of this study was to use the Canadian Neonatal Network (CNN) database to validate the Score for Neonatal Acute Physiology, Version II (SNAP-II) for prediction of mortality among CDH infants admitted to a neonatal intensive care unit (NICU), and to compare this to the predictive equation recently developed by the Congenital Diaphragmatic Hernia Study Group (CDHSG).

STUDY DESIGN:

Infants with CDH in the CNN database were identified. Bivariate and multivariable logistic regression models were used to identify risk factors predictive of mortality. Model predictive performance and calibration were assessed using the area under the receiver operator characteristic curve and the technique of Hosmer-Lemeshow, respectively, and compared with the CDHSG predictive equation.

RESULTS:

There were 88 patients with CDH among 19,507 admissions to CNN hospitals. The mortality rate among CDH patients surviving to NICU admission was 17%, and 12.5% received extracorporeal membrane oxygenation therapy. Gestational age and admission SNAP-II score predicted mortality. Model predictive performance and calibration were optimized with these variables combined. The CDHSG equation was equally predictive of mortality, but was only marginally calibrated.

CONCLUSIONS:

SNAP-II is highly predictive of mortality among patients with CDH, and can be used to risk-adjust these patients.

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Acknowledgements

This study was supported by Grant 40503 and Grant 00152 from the Medical Research Council of Canada. Additional funding was provided by the B.C.'s Children's Hospital Foundation; Calgary Regional Health Authority; Division of Neonatology, Children's Hospital of Eastern Ontario; Child Health Program, Dalhousie University Neonatal Perinatal Research Fund; Health Care Corporation of St. John's; The Neonatology Program, Hospital for Sick Children; Lawson Research Institute; Midland Walwyn Capital Inc; Division of Neonatology, Hamilton Health Sciences Corporation; Mount Sinai Hospital; North York General Hospital Foundation; Saint Joseph's Health Centre; University of Saskatchewan Neonatal Research Fund; University of Western Ontario; Women's College Hospital. We thank Jennifer Claydon for her assistance in data collection and manuscript preparation.

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Authors and Affiliations

  1. Department of Surgery, Children's and Women's Health Centre of British Columbia, the University of British Columbia, Vancouver, B.C., Canada

    Erik D Skarsgard MD

  2. Department of Pediatrics, Children's and Women's Health Centre of British Columbia, the University of British Columbia, Vancouver, B.C., Canada

    Ruth Little MBBS & Shoo K Lee MBBS, PhD

  3. Department of Health Care and Epidemiology, the University of British Columbia, Vancouver, B.C., Canada

    Ying C MacNab PhD & Zhenguo Qiu PhD

  4. the Canadian Neonatal Network,

    Erik D Skarsgard MD, Ying C MacNab PhD, Zhenguo Qiu PhD, Ruth Little MBBS & Shoo K Lee MBBS, PhD

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  1. Erik D Skarsgard MD
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  5. Shoo K Lee MBBS, PhD
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The Canadian Neonatal Network

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Skarsgard, E., MacNab, Y., Qiu, Z. et al. SNAP-II Predicts Mortality among Infants with Congenital Diaphragmatic Hernia. J Perinatol 25, 315–319 (2005). https://doi.org/10.1038/sj.jp.7211257

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