A comparison of CRIB, CRIB II, SNAP, SNAPII and SNAP-PE scores for prediction of mortality in critically ill neonates

Background: Clinical Risk Index of Babies (CRIB), Score for Neonatal Acute Physiology (SNAP), an update of the Clinical Risk Index for Babies score (CRIB II) and Score for Neonatal Acute Physiology - Perinatal Extension (SNAP-PE) are scoring devices developed in neonatal intensive care units. This study reviewed these scoring systems in critically ill neonates to determine how well they could predict mortality. Methods: This prospective cohort study was conducted at the neonatal intensive care units of Mofid and Mahdieh hospitals between March 2006 and May 2009. We evaluated CRIB, CRIB II, SNAP, SNAPII and SNAP-PE score for each neonate and the final scores were then obtained. The predictive accuracy of these parameters were expressed as area under the receiver operative characteristic curve, sensitivity, specificity, positive predictive value and negative predictive value. Results: Of 404 neonate evaluated 53% were male. Primary diagnoses were respiratory distress syndrome, gastrointestinal obstruction, sepsis, prematurity, and neuromuscular diseases. The authors detected mortality in 20.5% and found a significant difference in scoring systems between survived and death groups. The mean CRIB score in survived neonates was 2.57±3.66 and in death neonates 8.43±4.66 (p value<0.001). We also found that the SNAP score had the highest area under the curve and the highest sensitivity, specificity, positive predictive value, negative predictive value and we had the lowest score for CRIB II. Conclusion: We concluded that the neonatal scoring systems could be a useful tool for prediction of mortality in NICUs and SNAP can predict the mortality better than the others.