Score for neonatal acute physiology II predicts mortality and persistent organ dysfunction in neonates with severe septicemia.

OBJECTIVE To investigate the relationship between score for neonatal acute physiology II (SNAP II) applied within 12 hours from the onset of severe sepsis, and death and persistent organ dysfunction (OD). DESIGN Prospective cohort study. SETTING Level III neonatal intensive care unit. PARTICIPANTS Neonates with severe sepsis. INTERVENTION SNAP II was applied within the first 12 hours from the onset of severe sepsis. Neonates with major malformations, severe asphyxia and prior blood products were excluded. MAJOR OUTCOME MEASURE: Death at day 14 from enrolment. RESULTS Forty neonates completed the study. Twenty-five died within 14 days. The median SNAP II was significantly higher in babies who died versus those who survived [median (IQR): 43 (36-53.5) vs 18 (16-37), P<0.001]. A SNAP II greater than 40 had 88% positive predictive value for death and persistent OD each, and 86.6% and 86% specificity for death and persistent OD, respectively. On day 14 from enrolment, more organs normalized/improved in the subjects with SNAP II of < or = 40. Perfusion related SNAP II parameters were significantly associated with death and organ dysfunction. CONCLUSIONS Severely septicemic neonates with high SNAP II scores (>40) have a higher risk of dying and persistent organ dysfunction. Individual SNAP II parameters do not contribute equally in prediction of mortality.