Predictive value of Score for Neonatal Acute Physiology and Perinatal Extension II for neonatal mortality in Sanglah Hospital, Denpasar, Indonesia

Background Neonatal mortality, which is largely caused by severe illness, is the biggest contributor to overall infant mortality. The World Health Organization (WHO) estimated that 4 million neonates die yearly worldwide, often due to severe infection and organ system immaturity. Neonates with severe illness require treatment in the neonatal intensive care unit (NICU), in which a reliable assessment tool for illness severity is needed to guide intensive care requirements and prognosis. Neonatal disease severity scoring systems have been developed, including Score for Neonatal Acute Physiology and Perinatal Extension II (SNAPPPPE II), but it has never been validated in our setting. Objective To study the prognostic value of SNAPP E II as a predictor of neonatal mortality in Sanglah Hospital, Denpasar, Indonesia. Methods This prospective cohort study was conducted in the NICU of Sanglah Hospital, Denpasar from November 2014 to February 2015. All neonates, except those with congenital anomaly, were observed during the first 12 hours of admission and their outcomes upon discharge from the NICU was recorded. We assessed the SNAPPPPE II cut-off point to predict neonatal mortality. The calibration of SNAPPPPE II was done using the Hosmer-Lemeshow goodness-of-fit test, and discrimination of SNAPP E II was determined from the receiver-operator characteristic (ROC) curve and area under the curve (AUC) value calculation. Results During the period of study, 63 children were eligible, but 5 were excluded because of major congenital abnormalities. The SNAPP E II optimum cut-off point of 37 gave a high probability of mortality and the ROC showed an AUC of 0.92 (95%CI 0.85 to 0.99). The Hosmer-Lemeshow goodness-of-fit test showed a good calibration with P=1.0 Conclusion The SNAPP E II has a good predictive ability for neonatal mortality in Sanglah Hospital, Denpasar, Indonesia.[Paediatr Indones. 2016;56:257-61. doi: 10.14238/pi56.4.2016.257-61]. The WHO estimates that four million newborns die each year, and 75% of these occur in the first week of life. The most common causes of neonatal death are infection (36%), prematurity (28%), and congenital abnormalities (7%). The mortality rate from severe illness in neonates was estimated to be 16 to 30%.1 Approximately 16% of neonates in the United States die from severe illness, and that in the UK in 1996-1997 was 10%.2 The incidence of neonatal severe illness in developing countries is quite high, at 1.8 to 18 per 1000. In Cipto Mangunkusumo Hospital, neonatal mortality rates from severe illness reached 14%.3 The Neonatology Department of Sanglah Hospital, Denpasar reported in 2009 that of 159 neonatal deaths, 42.7% of deaths were due to respiratory distress, 17.6% due to sepsis, and 9.4% due to low birth weight and other causes.4 The initial handling of neonatal emergencies (resuscitation) and the availability of the NICU are critical to the prognosis and the likelihood of death From the Department of Child Health, Udayana University Medical School/ Sanglah Hospital, Denpasar, Indonesia. Reprint requests to: I Gede Ketut Aryana, Department of Child Health, Udayana University Medical School, Sanglah Hospital, Jl. Pulau Nias, Denpasar, Bali. Tel./Fax: +62 361-244038; E-mail: aryana7416@yahoo.com.