GIÁ TRỊ CỦA THANG ĐIỂM SNAP-II VÀ CÁC YẾU TỐ LIÊN QUAN TRONG TIÊN LƯỢNG TỬ VONG Ở TRẺ SƠ SINH TẠI BỆNH VIỆN NHI ĐỒNG 1

Abstract

Background: Neonatal mortality is a major concern in many countries, including Vietnam, as this indicator clearly reflects the quality of healthcare and the effectiveness of the national health system. Internationally, the SNAP-II score (Score for Neonatal Acute Physiology II) was developed by Richardson based on the foundation of the previous SNAP score. In Vietnam, the study by Nguyen Thi Kim Nhi (2021) evaluated the prognostic value of the SNAP-II score for mortality in the Neonatal Intensive Care Unit. Clinical practice at Children’s Hospital 1 shows that the majority of neonates admitted to the Neonatal Intensive Care Unit are in critical condition with a high risk of mortality. Early assessment of mortality risk is essential to support timely and appropriate diagnostic and therapeutic decisions, particularly for high-risk cases. Based on this clinical reality, we conducted this study to evaluate the prognostic ability of the SNAP-II score for neonatal mortality.Objective: To identify factors associated with mortality and the prognostic value of the SNAP-II score for mortality in neonates admitted to the Neonatal Intensive Care Unit at 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 assessed at two time points: T0 (upon admission) and T24 (24 hours after admission).

Results: The study included 182 neonates, with a median gestational age of 36.6 weeks (interquartile range: 34.0–38.0 weeks) and a median birth weight of 2455 g (1800–3000 g). The most prominent clinical manifestations upon admission to the NICU were respiratory disorders (81.9%) and gastrointestinal disorders (36.2%). The rate of shock within the first 24 hours of admission was 13.7%, and the overall mortality rate was 11%. The results demonstrated that the SNAP-II score had excellent prognostic value, with outstanding discriminative ability between survivors and non-survivors at both assessment time points. At T0 (upon admission), the optimal cutoff point was 27, corresponding to a mortality rate of 8.8%, sensitivity of 80%, specificity of 91.3%, AUC = 0.917, and Youden’s J index = 0.714. At T24 (24 hours after admission), the optimal cutoff point was 12, corresponding to a mortality rate of 10.4%, sensitivity of 95%, specificity of 89.5%, AUC = 0.964, and Youden’s J index = 0.845. Univariate analysis identified factors associated with mortality, including gestational age <28 weeks, birth weight <1500 g, shock within the first 24 hours of admission, neutropenia, blood pH <7.2, SNAP-II (T0) ≥27, and SNAP-II (T24) ≥12. Multivariate logistic regression analysis revealed four independent risk factors with statistical significance associated with neonatal mortality: gestational age <28 weeks, birth weight <1500 g, shock within the first 24 hours of NICU admission, and SNAP-II (T24) ≥12.

Conclusion: In summary, the study reported an overall neonatal mortality rate of 11%. The SNAP-II score demonstrated excellent prognostic performance at both T0 and T24 time points, with four independent risk factors for mortality: gestational age <28 weeks, birth weight <1500 g, shock within the first 24 hours of NICU admission, and SNAP-II (T24) score ≥12.