Neonatal Mortality Risk Assessment in a Neonatal Intensive Care Unit (NICU)

Objective: This study aims to assess the utility of a scoring system as predictor of neonatal mortality rate among the neonates admitted within one year to the neonatal intensive care unit (NICU) of the Children’s Medical Center in Tehran, Iran. Material & Methods: Data were gathered from 213 newborns admitted to the NICU from September 2003 to August 2004. In addition to demographic data, Apgar scores at 1 minute and 5 minutes, history and duration of previous hospitalization, initial diagnosis and final diagnosis, and scoring system by using the score for the neonatal acute physiology-perinatal extension II (SNAP-PE II) were carried out within 12 hours after admission to the NICU. All of the parameters were prospectively applied to the admitted newborns. The exclusion criteria were discharge or death in less than 24 hours after NICU admission. Findings: 198 newborn infants met the inclusion criteria. The mean and standard deviation (SD) of the variables including postnatal age, birth weight, SNAP, and finally Apgar scores at 1 minute and 5 minutes of neonates under this study were 7.6 (0.5) days, 2479.8 (29.4) grams, 21.6 (1.1), 7.47( 0.08), and 7.71 (0.06), respectively. Twenty five of the 198 patients died (12.6%). Gestational age (P=0.03), birth weight (P=0.02), Apgar score at 5 minutes (0.001), and SNAP-PE II (P=0.04) were significantly related to the mortality rate. By Analyzing through logistic regression to evaluate the predictive value of these variables in relation to the risk of mortality, it was shown that only SNAPPE II and Apgar score at 5 minutes could significantly predict the neonatal mortality. Conclusion: According to this study SNAP-PE II and Apgar score at 5 minutes can be used to predict mortality among the NICU patients. SNAP-PE II score had the best performance in predicting mortality in this study. More studies with larger samples are suggested to evaluate all of the abovementioned parameters among neonates who are admitted to NICUs countrywide.