ĐÁNH GIÁ TIÊN LƯỢNG TỬ VONG BẰNG THANG ĐIỂM SNAP-II TẠI KHOA HỒI SỨC SƠ SINH BỆNH VIỆN NHI ĐỒNG 1

Abstract

Background: Neonatal mortality is a critical issue of concern in many countries, including Vietnam, as it reflects the quality of healthcare in each nation. Globally, Richardson developed the SNAP-II score based on the Score for Neonatal Acute Physiology (SNAP). In Vietnam, a study in 2019 evaluated mortality prognosis in the Neonatal Intensive Care Unit (NICU) using the SNAP-II score. At our facility, Children's Hospital 1, all neonates admitted to the NICU are critically ill and at high risk of mortality. Assessing mortality prognosis is essential to facilitate prompt and appropriate diagnosis and management for cases with a high mortality risk. We conducted this study to evaluate mortality prognosis using the SNAP-II score. Objectives: To determine the use SNAP-II score in neonates at the NICU of Children's Hospital 1. Methods: A cross-sectional study was conducted from January 1, 2025, to June 30, 2025, at Children's Hospital 1. The SNAP-II score was evaluated at T0 (at admission) and T24 (24 hours after admission). Results: There were 182 neonatal cases evaluated during the study period. The median gestational age was 36.6 weeks (34.0 – 38.0 weeks), median birth weight was 2455g (1800 – 3000g), and the proportion of extremely preterm infants was 3.9%. Common diagnoses included prematurity (50.0%), sepsis (39.0%), congenital heart disease (29.1%), and pneumonia (23.0%). Primary treatments included antibiotic therapy (98.9%), mechanical ventilation (84.1%), NCPAP (48.4%), and vasopressor use (29.7%). The mortality rate was 11.0%. The SNAP-II score at T0 was 15 (8 – 22). The values of mortality-related factors in the general population at T0 according to the SNAP-II score, recorded as the proportion of patients with abnormal values, were: urine output (63.2%), body temperature (52.7%), PO₂/FiO₂ ratio (49.5%), lowest blood pH (13.7%), mean arterial pressure (2.7%) and multiple seizures (1.0%). The SNAP-II score at T24 was 5 (0 – 7). The values of mortality-related factors in the general population at T24 according to the SNAP-II score, recorded as the proportion of patients with abnormal values, were: PO₂/FiO₂ ratio (43.4%), lowest blood pH (18.7%), urine output (15.9%), mean arterial pressure (3.3%), body temperature (1.5%) and multiple seizures (0.5%). Conclusion: The mortality rate was 11.0%. The SNAP-II score at T0 was 15 (8 – 22) and at T24 was 5 (0 – 7). The most common mortality-related factors according to the SNAP-II score, recorded as the proportion of patients with abnormal values, were urine output (63.2%) and body temperature (52.7%) at T0, and PO₂/FiO₂ ratio (43.4%) and lowest blood pH (18.7%) at T24.