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Improved SNAPPE-II and CRIB II scores over a 15-year period

Journal of Perinatology volume 37, pages 547–551 (2017)Cite this article

Subjects

Abstract

Objective:

During the last decades mortality and morbidity of preterm infants have declined in the Western world. We hypothesized that the decrease in mortality in preterm infants was associated with a decrease in illness severity scores (SNAPPE-II and CRIB II scores).

Study Design:

Subjects were inborn infants born between January 1997 and December 1999 (period 1) and between January 2006 and December 2011 (period 2) with a gestational age of 26+0 through 28+6 weeks and without congenital malformations (n=394). SNAPPE-II, CRIB II scores, mortality, severe morbidity and survival without morbidity were recorded. Outcomes between the two periods were analyzed using multivariable analysis.

Results:

SNAPPE-II, but not CRIB II, scores were significantly lower for all GAs in period 2 compared with period 1. The risk of mortality for identical SNAPPE-II scores and CRIB II scores did not differ between the two periods. The risk of morbidity for identical SNAPPE-II scores and CRIB II scores was significantly lower in period 2 versus period 1. Hence, the chance of survival without morbidity for identical SNAPPE-II scores and CRIB II scores increased significantly in period 2 versus period 1.

Conclusions:

SNAPPE-II, but not CRIB II, scores decreased over 15 years. The risk of mortality for identical SNAPPE-II and CRIB II scores did not change, but the risk of morbidity decreased and the chance of survival without morbidity increased for identical SNAPPE-II and CRIB II scores. These findings suggest substantial improvements in both obstetrical and neonatal care.

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References

  1. Brazy JE, Eckerman CO, Oehler JM, Goldstein RF, O'Rand AM . Nursery neurobiologic risk score: important factor in predicting outcome in very low birth weight infants. J Pediatr 1991; 118: 783–792.

    Article  CAS  PubMed  Google Scholar 

  2. The International Neonatal Network. The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. The International Neonatal Network [published erratum appears in Lancet 1993; 342(8871): 626]. Lancet 1993; 342: 193–198.

    Article  Google Scholar 

  3. Gray JE, Richardson DK, McCormick MC, Workman-Daniels K, Goldmann DA . Neonatal therapeutic intervention scoring system: a therapy-based severity-of-illness index. Pediatrics 1992; 90: 561–567.

    CAS  PubMed  Google Scholar 

  4. Richardson DK, Gray JE, McCormick MC, Workman K, Goldmann DA . Score for neonatal acute physiology: a physiologic severity index for neonatal intensivecare. Pediatrics 1993; 91: 617–623.

    CAS  PubMed  Google Scholar 

  5. Richardson DK, Tarnow Mordi WO, Escobar GJ . Neonatal risk scoring systems. Can they predict mortality and morbidity? Clin Perinatol 1998; 25: 591–611.

    Article  CAS  PubMed  Google Scholar 

  6. Richardson DK, Corcoran JD, Escobar GJ, Lee SK . SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138: 92–100.

    Article  CAS  PubMed  Google Scholar 

  7. Dammann O, Shah B, Naples M, Bednarek F, Zupancic J, Allred EN et al. Interinstitutional variation in prediction of death by SNAP-II and SNAPPE-II among extremely preterm infants. Pediatrics 2009; 124: e1001–e1006.

    Article  PubMed  Google Scholar 

  8. Parry G, Tucker J, Tarnow-Mordi W . CRIB II: an update of the clinical risk index for babies score. Lancet 2003; 361: 1789–1791.

    Article  PubMed  Google Scholar 

  9. Ancel PY, Goffinet F, Kuhn P, Langer B, Matis J, Hernandorena X et al. Survival and morbidity of preterm children born at 22 through 34 weeks' gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr 2015; 169: 230–238.

    Article  PubMed  Google Scholar 

  10. Cooke RW . Preterm mortality and morbidity over 25 years. Arch Dis Child Fetal Neonatal Ed 2006; 91: F293–F294.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES . Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ 2012; 345: e7976.

    Article  PubMed  PubMed Central  Google Scholar 

  12. EXPRESS Group. Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS). Acta Paediatr 2010; 99: 978–992.

    Article  Google Scholar 

  13. Groenendaal F, Termote JU, van der Heide-Jalving M, van Haastert IC, de Vries LS . Complications affecting preterm neonates from 1991 to 2006: what have we gained? Acta Paediatr 2010; 99: 354–358.

    Article  CAS  PubMed  Google Scholar 

  14. Himmelmann K, Hagberg G, Uvebrant P . The changing panorama of cerebral palsy in Sweden. X. Prevalence and origin in the birth-year period 1999-2002. Acta Paediatr 2010; 99: 1337–1343.

    Article  CAS  PubMed  Google Scholar 

  15. Platt MJ, Cans C, Johnson A, Surman G, Topp M, Torrioli MG et al. Trends in cerebral palsy among infants of very low birthweight (<1500 g) or born prematurely (<32 weeks) in 16 European centres: a database study. Lancet 2007; 369: 43–50.

    Article  PubMed  Google Scholar 

  16. van Haastert IC, Groenendaal F, Uiterwaal CS, Termote JU, van der Heide-Jalving M, Eijsermans MJ et al. Decreasing incidence and severity of cerebral palsy in prematurely born children. J Pediatr 2011; 159: 86–91.

    Article  PubMed  Google Scholar 

  17. Zegers MJ, Hukkelhoven CW, Uiterwaal CS, Kollee LA, Groenendaal F . Changing Dutch approach and trends in short-term outcome of periviable preterms. Arch Dis Child Fetal Neonatal Ed 2016; 101: F391–F396.

    Article  PubMed  Google Scholar 

  18. Papile LA, Burstein J, Burstein R, Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92: 529–534.

    Article  CAS  PubMed  Google Scholar 

  19. de Vries LS, Eken P, Dubowitz LM . The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res 1992; 49: 1–6.

    Article  CAS  PubMed  Google Scholar 

  20. Jobe AH, Bancalari E . Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723–1729.

    Article  CAS  PubMed  Google Scholar 

  21. International Committee for the Classification of Retinopathy of Prematurity. The International classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005; 123: 991–999.

    Article  Google Scholar 

  22. Ruegger C, Hegglin M, Adams M, Bucher HU . Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years. BMC Pediatr 2012; 12: 17.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Gagliardi L, Cavazza A, Brunelli A, Battaglioli M, Merazzi D, Tandoi F et al. Assessing mortality risk in very low birthweight infants: a comparison of CRIB, CRIB-II, and SNAPPE-II. Arch Dis Child Fetal Neonatal Ed 2004; 89: F419–F422.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Pollack MM, Koch MA, Bartel DA, Rapoport I, Dhanireddy R, El-Mohandes AA et al. A comparison of neonatal mortality risk prediction models in very low birth weight infants. Pediatrics 2000; 105: 1051–1057.

    Article  CAS  PubMed  Google Scholar 

  25. Dorling JS, Field DJ, Manktelow B . Neonatal disease severity scoring systems. Arch Dis Child Fetal Neonatal Ed 2005; 90: F11–F16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Schuit E, Hukkelhoven CW, Manktelow BN, Papatsonis DN, de Kleine MJ, Draper ES et al. Prognostic models for stillbirth and neonatal death in very preterm birth: a validation study. Pediatrics 2012; 129: e120–e127.

    Article  PubMed  Google Scholar 

  27. Claas MJ, Bruinse HW, Koopman C, van Haastert IC, Peelen LM, de Vries LS . Two-year neurodevelopmental outcome of preterm born children ≤750 g at birth. Arch Dis Child Fetal Neonatal Ed 2011; 96: F169–F177.

    Article  CAS  PubMed  Google Scholar 

  28. Moore T, Hennessy EM, Myles J, Johnson SJ, Draper ES, Costeloe KL et al. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ 2012; 345: e7961.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Serenius F, Kallen K, Blennow M, Ewald U, Fellman V, Holmstrom G et al. Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden. JAMA 2013; 309: 1810–1820.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Dirk Kwakkel and Juliette Schuurmans for their help in obtaining the scores in a subset of patients.

Author information

Authors and Affiliations

  1. Department of Neonatology, Birth Center, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Utrecht, The Netherlands

    F Groenendaal & M C de Vos

  2. Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands

    F Groenendaal

  3. Department of Neonatology, Birth Center, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Utrecht, The Netherlands

    J B Derks & E J H Mulder

Authors
  1. F Groenendaal
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  2. M C de Vos
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  4. E J H Mulder
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Corresponding author

Correspondence to F Groenendaal.

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The authors declare no conflict of interest.

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Groenendaal, F., de Vos, M., Derks, J. et al. Improved SNAPPE-II and CRIB II scores over a 15-year period. J Perinatol 37, 547–551 (2017). https://doi.org/10.1038/jp.2016.276

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