Abstract
Objective:
During the last decades mortality and morbidity of preterm infants have declined in the Western world. We hypothesized that the decrease in mortality in preterm infants was associated with a decrease in illness severity scores (SNAPPE-II and CRIB II scores).
Study Design:
Subjects were inborn infants born between January 1997 and December 1999 (period 1) and between January 2006 and December 2011 (period 2) with a gestational age of 26+0 through 28+6 weeks and without congenital malformations (n=394). SNAPPE-II, CRIB II scores, mortality, severe morbidity and survival without morbidity were recorded. Outcomes between the two periods were analyzed using multivariable analysis.
Results:
SNAPPE-II, but not CRIB II, scores were significantly lower for all GAs in period 2 compared with period 1. The risk of mortality for identical SNAPPE-II scores and CRIB II scores did not differ between the two periods. The risk of morbidity for identical SNAPPE-II scores and CRIB II scores was significantly lower in period 2 versus period 1. Hence, the chance of survival without morbidity for identical SNAPPE-II scores and CRIB II scores increased significantly in period 2 versus period 1.
Conclusions:
SNAPPE-II, but not CRIB II, scores decreased over 15 years. The risk of mortality for identical SNAPPE-II and CRIB II scores did not change, but the risk of morbidity decreased and the chance of survival without morbidity increased for identical SNAPPE-II and CRIB II scores. These findings suggest substantial improvements in both obstetrical and neonatal care.
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References
Brazy JE, Eckerman CO, Oehler JM, Goldstein RF, O'Rand AM . Nursery neurobiologic risk score: important factor in predicting outcome in very low birth weight infants. J Pediatr 1991; 118: 783–792.
The International Neonatal Network. The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. The International Neonatal Network [published erratum appears in Lancet 1993; 342(8871): 626]. Lancet 1993; 342: 193–198.
Gray JE, Richardson DK, McCormick MC, Workman-Daniels K, Goldmann DA . Neonatal therapeutic intervention scoring system: a therapy-based severity-of-illness index. Pediatrics 1992; 90: 561–567.
Richardson DK, Gray JE, McCormick MC, Workman K, Goldmann DA . Score for neonatal acute physiology: a physiologic severity index for neonatal intensivecare. Pediatrics 1993; 91: 617–623.
Richardson DK, Tarnow Mordi WO, Escobar GJ . Neonatal risk scoring systems. Can they predict mortality and morbidity? Clin Perinatol 1998; 25: 591–611.
Richardson DK, Corcoran JD, Escobar GJ, Lee SK . SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138: 92–100.
Dammann O, Shah B, Naples M, Bednarek F, Zupancic J, Allred EN et al. Interinstitutional variation in prediction of death by SNAP-II and SNAPPE-II among extremely preterm infants. Pediatrics 2009; 124: e1001–e1006.
Parry G, Tucker J, Tarnow-Mordi W . CRIB II: an update of the clinical risk index for babies score. Lancet 2003; 361: 1789–1791.
Ancel PY, Goffinet F, Kuhn P, Langer B, Matis J, Hernandorena X et al. Survival and morbidity of preterm children born at 22 through 34 weeks' gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr 2015; 169: 230–238.
Cooke RW . Preterm mortality and morbidity over 25 years. Arch Dis Child Fetal Neonatal Ed 2006; 91: F293–F294.
Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES . Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ 2012; 345: e7976.
EXPRESS Group. Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS). Acta Paediatr 2010; 99: 978–992.
Groenendaal F, Termote JU, van der Heide-Jalving M, van Haastert IC, de Vries LS . Complications affecting preterm neonates from 1991 to 2006: what have we gained? Acta Paediatr 2010; 99: 354–358.
Himmelmann K, Hagberg G, Uvebrant P . The changing panorama of cerebral palsy in Sweden. X. Prevalence and origin in the birth-year period 1999-2002. Acta Paediatr 2010; 99: 1337–1343.
Platt MJ, Cans C, Johnson A, Surman G, Topp M, Torrioli MG et al. Trends in cerebral palsy among infants of very low birthweight (<1500 g) or born prematurely (<32 weeks) in 16 European centres: a database study. Lancet 2007; 369: 43–50.
van Haastert IC, Groenendaal F, Uiterwaal CS, Termote JU, van der Heide-Jalving M, Eijsermans MJ et al. Decreasing incidence and severity of cerebral palsy in prematurely born children. J Pediatr 2011; 159: 86–91.
Zegers MJ, Hukkelhoven CW, Uiterwaal CS, Kollee LA, Groenendaal F . Changing Dutch approach and trends in short-term outcome of periviable preterms. Arch Dis Child Fetal Neonatal Ed 2016; 101: F391–F396.
Papile LA, Burstein J, Burstein R, Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92: 529–534.
de Vries LS, Eken P, Dubowitz LM . The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res 1992; 49: 1–6.
Jobe AH, Bancalari E . Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723–1729.
International Committee for the Classification of Retinopathy of Prematurity. The International classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005; 123: 991–999.
Ruegger C, Hegglin M, Adams M, Bucher HU . Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years. BMC Pediatr 2012; 12: 17.
Gagliardi L, Cavazza A, Brunelli A, Battaglioli M, Merazzi D, Tandoi F et al. Assessing mortality risk in very low birthweight infants: a comparison of CRIB, CRIB-II, and SNAPPE-II. Arch Dis Child Fetal Neonatal Ed 2004; 89: F419–F422.
Pollack MM, Koch MA, Bartel DA, Rapoport I, Dhanireddy R, El-Mohandes AA et al. A comparison of neonatal mortality risk prediction models in very low birth weight infants. Pediatrics 2000; 105: 1051–1057.
Dorling JS, Field DJ, Manktelow B . Neonatal disease severity scoring systems. Arch Dis Child Fetal Neonatal Ed 2005; 90: F11–F16.
Schuit E, Hukkelhoven CW, Manktelow BN, Papatsonis DN, de Kleine MJ, Draper ES et al. Prognostic models for stillbirth and neonatal death in very preterm birth: a validation study. Pediatrics 2012; 129: e120–e127.
Claas MJ, Bruinse HW, Koopman C, van Haastert IC, Peelen LM, de Vries LS . Two-year neurodevelopmental outcome of preterm born children ≤750 g at birth. Arch Dis Child Fetal Neonatal Ed 2011; 96: F169–F177.
Moore T, Hennessy EM, Myles J, Johnson SJ, Draper ES, Costeloe KL et al. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ 2012; 345: e7961.
Serenius F, Kallen K, Blennow M, Ewald U, Fellman V, Holmstrom G et al. Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden. JAMA 2013; 309: 1810–1820.
Acknowledgements
We thank Dirk Kwakkel and Juliette Schuurmans for their help in obtaining the scores in a subset of patients.
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Groenendaal, F., de Vos, M., Derks, J. et al. Improved SNAPPE-II and CRIB II scores over a 15-year period. J Perinatol 37, 547–551 (2017). https://doi.org/10.1038/jp.2016.276
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DOI: https://doi.org/10.1038/jp.2016.276