Original Article

Journal of Perinatology (2005) 25, 315–319. doi:10.1038/sj.jp.7211257 Published online 17 February 2005

SNAP-II Predicts Mortality among Infants with Congenital Diaphragmatic Hernia

Erik D Skarsgard MD1, Ying C MacNab PhD3, Zhenguo Qiu PhD3, Ruth Little MBBS2 and Shoo K Lee MBBS, PhD2 The Canadian Neonatal Network4

  1. 1Department of Surgery (E.D.S.), Children's and Women's Health Centre of British Columbia, the University of British Columbia, Vancouver, B.C., Canada
  2. 2Department of Pediatrics (R.L., S.K.L.), Children's and Women's Health Centre of British Columbia, the University of British Columbia, Vancouver, B.C., Canada
  3. 3Department of Health Care and Epidemiology (Y.C.M., Z.Q.), the University of British Columbia, Varcouver, B.C., Canada
  4. 4the Canadian Neonatal Network

Correspondence: Erik D. Skarsgard, MD, Department of Surgery, Children's and Women's Health Centre of British Columbia, KO-123, 4480 Oak Street, Vancouver, B.C., Canada V6H 3V4

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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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