Measuring Illness Severity in Newborn Intensive Care

1994 ◽  
Vol 9 (1) ◽  
pp. 20-33 ◽  
Author(s):  
Douglas K. Richardson ◽  
William O. Tarnow-Mordi
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care ◽  
Pediatric Intensive Care ◽  
Scoring Systems ◽  
Illness Severity ◽  
Advantages And Disadvantages ◽  
Severity Scores ◽  
Potential Applications ◽  
And Performance

Measurement of illness severity has found increasing use in adult and pediatric intensive care research over the past decade. The development of illness severity indices for neonatal intensive care has lagged because birth weight has served as an excellent proxy for illness severity. However, a number of recent studies have shown marked variation in survival and morbidity among neonatal intensive care units (NICUs) despite birth weight adjustment, making clear the need for neonatal illness severity scoring. We discuss advantages and disadvantages of the 4 types of scoring systems used in adult intensive care—diagnosis, risk-factor, therapeutic, and physiological—and review their applications in adult and pediatric ICU research. Criteria for score design, as well as standards for validation and performance, are enumerated. The 30 neonatal scores fall in 5 major categories: obstetric risk, general use pediatric scores, predictors of developmental outcome, bronchopulmonary dysplasia risk, and acute mortality risk. Few have been adequately validated on large, concurrent independent samples. The most promising scores are those that measure acute physiological derangement on admission. Potential applications for these new illness severity scores are discussed.

Coagulase-Negative Staphylococcal Bacteremia Among Very Low Birth Weight Infants: Relation to Admission Illness Severity, Resource Use, and Outcome

PEDIATRICS ◽  
1995 ◽  
Vol 95 (2) ◽  
pp. 225-230 ◽  
Author(s):  
James E. Gray ◽  
Douglas K. Richardson ◽  
Marie C. McCormick ◽  
Donald A. Goldmann
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Resource Use ◽  
Cumulative Incidence ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Illness Severity ◽  
Incidence Density ◽  
Low Birth Weight Infants

Objective. To examine the impact of admission-day illness severity on nosocomial bacteremia risk after consideration of traditional risk determinants such as birth weight and length of stay. Methods. The hospital courses for 302 consecutive very low birth weight (less than 1500 g) infants admitted to two neonatal intensive care units were examined for the occurrence of nosocomial coagulase-negative staphylococcal bacteremia. Using both cumulative incidence and incidence density as measures of bacteremia risk, we explored the relation between illness severity (as measured by the Score for Neonatal Acute Physiology [SNAP]) and bacteremia both before and after birth weight adjustment. In addition, the effect of bacteremia on hospital resource use was estimated. Results. Coagulase-negative staphylococcus was the most common pathogen noted in blood cultures drawn at 48 hours after admission or later. It was isolated on at least one occasion in 53 patients (cumulative incidence of 17.5 first episodes per 100 patients). These episodes occurred during 7652 days at risk, giving an incidence density of 6.9 initial bacteremias per 1000 patient-days at risk. As expected, when compared with the nonbacteremic group, bacteremic patients were of lower birth weight (888 ± 231 vs 1127 ± 258 g; P < .01) and gestational age (26.4 ± 2.1 vs 28.9 ± 2.8 weeks; P < .01). In addition, these patients were more severely ill on admission (SNAP 17.3 ± 6.5 vs 12.2 ± 5.8; P < .01). Even after birth weight stratification, the risk of bacteremia by both measures increased with higher SNAP scores. For example, among infants with birth weights greater than 1 kg, 25% of the most severely ill patients (SNAP 20 and higher) experienced at least one bacteremic episode, whereas the rates seen in infants with intermediate (SNAP 10 to 19) and low illness severity (SNAP 0 to 9) were 8.6% and 3.0%, respectively (χ2 for trend = 7.25; P < .01). Multivariate linear regression showed that bacteremia was associated with a prolongation of neonatal intensive care unit stay of 14.0 ± 4.0 days (P < .01) and an increase in hospital charges of $25 090 ± 12 051 (P < .05), even after adjustment for birth weight and admission-day SNAP. Conclusions. Nosocomial coagulase-negative bacteremia is an important complication among very low birth weight infants. Assessment of illness severity with SNAP provides information regarding nosocomial infection risk beyond that available from birth weight alone.

Birth Weight and Illness Severity: Independent Predictors of Neonatal Mortality

PEDIATRICS ◽  
1993 ◽  
Vol 91 (5) ◽  
pp. 969-975 ◽  
Author(s):  
Dougbas K. Richardson ◽  
Ciaran S. Phibbs ◽  
James E. Gray ◽  
Marie C. McCormick ◽  
Kathryn Workman-Daniels ◽  
...  
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Mortality ◽  
Intensive Care Units ◽  
Logistic Model ◽  
Neonatal Intensive Care ◽  
Goodness Of Fit ◽  
Clinical Score ◽  
Illness Severity ◽  
Major Determinant

Background. Low birth weight is a major determinant of neonatal mortality. Yet birth weight, even in conjunction with other demographic markers, is inadequate to explain the large variations in neonatal mortality between intensive care units. This variation probably reflects differences in admission severity. The authors have recently developed the Score for Neonatal Acute Physiology (SNAP), an illness severity index specific for neonatal intensive care, and demonstrated illness severity to be a major determinant of neonatal mortality. Objective. To define the relative contributions of birth weight and illness severity to the risk of neonatal mortality and to identify other significant independent risk factors. Methods. Logistic regression was used to analyze data from a cohort of 1621 consecutive admissions to three neonatal intensive care units (92 deaths), to test six alternative predictive models. The best logistic model was then used to develop a simple additive clinical score, the SNAP Perinatal Extension (SNAP-PE). Results. These analyses demonstrated that birth weight and illness severity are powerful independent predictors across a broad range of birth weights and that their effects are additive. Below 750 g, there is an interaction between birth weight and SNAP. Other factors that showed independent predictive power were low Apgar score at 5 minutes and small size for gestational age. Separate derivation and test samples were used to demonstrate that the SNAP-PE is comparable to the best logistic model and has a sensitivity and specificity superior to either birth weight or SNAP alone (receiver-operator characteristic area .92 ± .02) as well as excellent goodness of fit. Conclusion. This simplified clinical score provides accurate mortality risk estimates for application in a broad array of clinical and research settings.

Score for Neonatal Acute Physiology: A Physiologic Severity Index for Neonatal Intensive Care

PEDIATRICS ◽  
1993 ◽  
Vol 91 (3) ◽  
pp. 617-623 ◽  
Author(s):  
Douglas K. Richardson ◽  
James E. Gray ◽  
Marie C. McCormick ◽  
Kathryn Workman ◽  
Donald A. Goldmann
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Mortality Risk ◽  
Neonatal Intensive Care ◽  
Severity Index ◽  
Illness Severity ◽  
Neonatal Intensive Care Units ◽  
Nursing Workload ◽  
Substantial Variation ◽  
Therapeutic Intensity

The substantial variation in birth weight-adjusted mortality among neonatal intensive care units (NICUs) may reflect differences in population illness severity. Development of an illness severity measure is essential for comparisons of outcomes. The Score for Neonatal Acute Physiology (SNAP) was developed and validated prospectively on 1643 admissions (114 deaths) in three NICUs. SNAP scores the worst physiologic derangements in each organ system in the first 24 hours. SNAP showed little correlation with birth weight and was highly predictive of neonatal mortality even within narrow birth weight strata. It was capable of separating patients into groups with 2 to 20 times higher mortality risk. It also correlated highly with other indicators of severity including nursing workload (r = .59), therapeutic intensity (r = .78), physician estimates of mortality risk (r = .65), and length of stay (R2 = .59). SNAP is an important new tool for NICU research.

Neonatal Therapeutic Intervention Scoring System: A Therapy-Based Severity-of-Illness Index

PEDIATRICS ◽  
1992 ◽  
Vol 90 (4) ◽  
pp. 561-567 ◽  
Author(s):  
James E. Gray ◽  
Douglas K. Richardson ◽  
Marie C. McCormick ◽  
Kathryn Workman-Daniels ◽  
Donald A. Goldmann
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Therapeutic Intervention ◽  
Scoring System ◽  
Neonatal Intensive Care ◽  
Severity Of Illness Index ◽  
Severity Of Illness ◽  
Illness Severity ◽  
Hospital Charges ◽  
Therapeutic Intervention Scoring System

Severity-of-illness scales have proven valuable able in assessing clinical outcomes and resource consumption in adult and pediatric intensive care, but they have been less extensively developed for neonatal care. The National Therapeutic Intervention Scoring System (NTISS) was created by modifying the Therapeutic Intervention Scoring System (TISS). From the 76 original TISS items, 42 were deleted and 28 added to form the NTISS. Like TISS, NTISS assigns score points from 1 to 4 for various intensive care therapies. Admission-day NTISS scores were calculated for 1643 newborns admitted to three neonatal intensive care units (NICUs) between November 1, 1989, and September 30, 1990. NTISS scores ranged from 0 to 47 with a mean of 12.3 ± 8.7 (SD). There was little correlation with birth weight (r = -.11) or gestational age (r = -.17), but NTISS scores were highly correlated with expected markers of illness severity, including mortality risk estimates by neonatal attending physicians (r = .70, P < .0001), in-hospital mortality rates (P < .05), and a measure of nursing acuity (Medicus) (r = .05), and a measure of nursing acuity (Medicus) (r = .69, P < .0001). In addition, admission-day NTISS scores were found to be predictive of both NICU length of stay (r = .37, P < .0001) and total hospital charges for survivors (r = .65, P < .0001). It is concluded that NTISS is a valid measure of therapeutic intensity that is independent of birth weight and can be used as an indicator of neonatal illness severity and resource utilization. Further validation in other NICUs is required.

scholarly journals Performance of intensive care unit severity scoring systems across different ethnicities

2021 ◽  
Author(s):  
Rahuldeb Sarkar ◽  
Christopher Martin ◽  
Heather Mattie ◽  
Judy Wawira Gichoya ◽  
David J. Stone ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
African Americans ◽  
Ethnic Groups ◽  
Medical Information ◽  
Scoring Systems ◽  
Illness Severity ◽  
Research Database ◽  
Severity Scoring ◽  
Severity Scores

ABSTRACTBackgroundDespite wide utilisation of severity scoring systems for case-mix determination and benchmarking in the intensive care unit, the possibility of scoring bias across ethnicities has not been examined. Recent guidelines on the use of illness severity scores to inform triage decisions for allocation of scarce resources such as mechanical ventilation during the current COVID-19 pandemic warrant examination for possible bias in these models. We investigated the performance of three severity scoring systems (APACHE IVa, OASIS, SOFA) across ethnic groups in two large ICU databases in order to identify possible ethnicity-based bias.MethodData from the eICU Collaborative Research Database and the Medical Information Mart for Intensive Care were analysed for score performance in Asians, African Americans, Hispanics and Whites after appropriate exclusions. Discrimination and calibration were determined for all three scoring systems in all four groups.FindingsWhile measurements of discrimination -area under the receiver operating characteristic curve (AUROC) -were significantly different among the groups, they did not display any discernible systematic patterns of bias. In contrast, measurements of calibration -standardised mortality ratio (SMR) -indicated persistent, and in some cases significant, patterns of difference between Hispanics and African Americans versus Asians and Whites. The differences between African Americans and Whites were consistently statistically significant. While calibrations were imperfect for all groups, the scores consistently demonstrated a pattern of over-predicting mortality for African Americans and Hispanics.InterpretationThe systematic differences in calibration across ethnic groups suggest that illness severity scores reflect bias in their predictions of mortality.FundingLAC is funded by the National Institute of Health through NIBIB R01 EB017205. There was no specific funding for this study.

Mothers of Infants With Congenital Diaphragmatic Hernia Describe “Breastfeeding” in the Neonatal Intensive Care Unit: “As Long as It’s My Milk, I’m Happy”

2017 ◽  
Vol 33 (3) ◽  
pp. 524-532 ◽  
Author(s):  
Elizabeth B. Froh ◽  
Janet A. Deatrick ◽  
Martha A. Q. Curley ◽  
Diane L. Spatz
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Neonatal Intensive Care ◽  
Safety Net ◽  
Prospective Longitudinal

Background: Very little is known about the breastfeeding experience of mothers of infants born with congenital anomalies and cared for in the neonatal intensive care unit (NICU). Often, studies related to breastfeeding and lactation in the NICU setting are focused on the mothers of late preterm, preterm, low-birth-weight, and very-low-birth-weight infants. Congenital diaphragmatic hernia (CDH) is an anatomic malformation of the diaphragm and affects 1 in every 2,000 to 4,000 live births. Currently, there are no studies examining the health outcomes of infants with CDH and the effect of human milk. Research aim: This study aimed to describe the breastfeeding experience of mothers of infants with CDH cared for in the NICU. Methods: A prospective, longitudinal qualitative descriptive design was used. Phased interviews were conducted with a purposive sample of 11 CDH infant–mother dyads from a level 3 NICU in a children’s hospital. Results: Six themes emerged from the data: (a) hopeful for breastfeeding, (b) latching on . . . to the pump, (c) we’ve already worked so hard, (d) getting the hang of it—it’s getting easier, (e) a good safety net, and (f) finding a way that works for us. Conclusion: For this population of CDH infant–mother dyads, the term breastfeeding is not exclusive to direct feeding at the breast and the mothers emphasized the significance of providing their own mother’s milk through a combination of feeding mechanisms to their infants with CDH.

Evaluation of Morbidities and Complications of Neonatal İntensive Care Unit Patients with Respiratory Disorders at Different Gestational Ages

2021 ◽  
Author(s):  
Erbu Yarci ◽  
Fuat E. Canpolat
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Respiratory Distress ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Respiratory Diseases ◽  
Respiratory Disorders ◽  
Live Births

Objective Respiratory distress presented within the first few days of life is life-threatening and common problem in the neonatal period. The aim of this study is to estimate (1) the incidence of respiratory diseases in newborns and related mortality; (2) the relationship between acute neonatal respiratory disorders rates and gestational age, birth weight, and gender; and (3) the incidence of complications associated with respiratory disturbances. Study Design Only inborn patients with gestational age between 230/7 and 416/7 weeks having respiratory distress were included in the study. The data were collected from the medical records and gestational age was based on the menstrual dating. Results There were 8,474 live births between January 1, 2013 and June 30, 2013 in our hospital. A total of 1,367 newborns were hospitalized and oxygen therapy was applied in 903 of them because of respiratory distress. An acute respiratory disorder was found to be in 10.6% (903/8,474) among all live births. Mortality was 0.76% (66/8,474). The incidence of respiratory distress syndrome was 2.8% (n = 242). The occurrence of transient tachypnea of newborn was 3.1% (n = 270). Meconium aspiration syndrome, pneumonia, congenital diaphragmatic hernia, and pulmonary maladaptation and primary persistent pulmonary hypertension rates were 0.1, 0.7, 2.2, and 0%, respectively. Overall, 553 (61%) of the 903 newborns having respiratory diseases had complications. The occurrence of necrotizing enterocolitis, patent ductus arteriosus, bronchopulmonary dysplasia, intraventricular hemorrhage and air leak was 6.8, 19.8, 4.7, 24.9, and 5%, respectively. Conclusion This study offers an epidemiological perspective for respiratory disorders from a single-center level-III neonatal intensive care unit. Although number of births, premature newborns, extremely low birth weight/very low birth weight infants, and complicated pregnancies increase in years, decreasing rates of mortality and complications are very promising. As perinatal and neonatal cares are getting better in every day, we think that more promising results can be achieved over the coming years. Key Points

scholarly journals The use of score for neonatal acute physiology perinatal extention II (SNAPPE II) in predicting neonatal outcome in neonatal intensive care unit

2016 ◽  
Vol 45 (6) ◽  
pp. 241
Author(s):  
Mia R A ◽  
Risa Etika ◽  
Agus Harianto ◽  
Fatimah Indarso ◽  
Sylviati M Damanik
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Characteristic Curve ◽  
Newborn Care ◽  
Scoring Systems ◽  
Laboratory Observation ◽  
The Mean ◽  
Overall Mortality

Background Scoring systems which quantify initial risks have animportant role in aiding execution of optimum health services by pre-dicting morbidity and mortality. One of these is the score for neonatalacute physiology perinatal extention (SNAPPE), developed byRichardson in 1993 and simplified in 2001. It is derived of 6 variablesfrom the physical and laboratory observation within the first 12 hoursof admission, and 3 variables of perinatal risks of mortality.Objectives To assess the validity of SNAPPE II in predicting mor-tality at neonatal intensive care unit (NICU), Soetomo Hospital,Surabaya. The study was also undertaken to evolve the best cut-offscore for predicting mortality.Methods Eighty newborns were admitted during a four-month periodand were evaluated with the investigations as required for the specifi-cations of SNAPPE II. Neonates admitted >48 hours of age or afterhaving been discharged, who were moved to lower newborn care <24hours and those who were discharged on request were excluded. Re-ceiver operating characteristic curve (ROC) were constructed to derivethe best cut-off score with Kappa and McNemar Test.Results Twenty eight (35%) neonates died during the study, 22(82%) of them died within the first six days. The mean SNAPPE IIscore was 26.3+19.84 (range 0-81). SNAPPE II score of thenonsurvivors was significantly higher than the survivors(42.75+18.59 vs 17.4+14.05; P=0.0001). SNAPPE II had a goodperformance in predicting overall mortality and the first-6-daysmortality, with area under the ROC 0.863 and 0.889. The best cut-off score for predicting mortality was 30 with sensitivity 81.8%,specificity 76.9%, positive predictive value 60.0% and negativepredictive value 90.0%.Conclusions SNAPPE II is a measurement of illness severity whichcorrelates well with neonatal mortality at NICU, Soetomo Hospital.The score of more than 30 is associated with higher mortality

scholarly journals Perinatal Outcome of the Second Twin

2015 ◽  
Vol 10 (1) ◽  
pp. 89-93
Author(s):  
R Joshi ◽  
G Baral
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Mode Of Delivery ◽  
Admission Rate ◽  
Second Twin

Aims: The purpose of this study was to determine the perinatal outcome of the second twin compared to the first one. Methods: This is a hospital based comparative study of 60 pregnant women with twin pregnancy at Paropakar Maternity and Women’s Hospital, Kathmandu from 14 January 2013 to13 April 2013. Apgar score and admission to neonatal intensive care unit of the first and the second twins were studied in relation to the gestational age, chorionicity, mode of delivery, inter-delivery interval and birth weight. Mc Nemars test was used with 0.05 as the level of significance. Results: Among 60 sets of twins, Apgar score of the second twin was found to be lower than the first one (p=0.02) in general and in preterm gestation (p=0.049), dichorionic diamniotic chorionicity (p=0.012), vaginal delivery (p<0.001), inter-delivery interval of <30 minutes (p=0.007) and birth weight discordance of <30 % (p=0.014). Admission to neonatal intensive care unit was not significant (p=0.5). Conclusions: Second twin had low Apgar score and the neonatal admission rate was similar for both twins. 

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