Severidad al ingreso a las Unidades de Cuidados Intensivos Neonatales. Estudio Multicéntrico

Abstract

Introduction: The measurement of illness severity on admission to Neonatal Intensive Care Unit (NICU) permits more appropriate outcomes classification, use of resources, and, therefore, the effectiveness of these units.

Material and Methods: We carried out a descriptive, prospective multi-center study at three NICUs, level IV, in Lima, Peru. We used the Score for Neonatal Acute Physiology (SNAP II) to capture illness severity on admission for a sequential cohort of all newborn infants admitted to the 3 neonatal intensive care units. Data on patient characteristics and outcomes of the patients were obtained in each NICU participating during a period of two months of data collection between January and June 2002.

Results: The three NICUs at Lima cared for 216 patients in two months, which is equivalent to about 20% from last year. After exclusion of 12 patients, because they have died or left the NICU before 24 hours of admission, we analyzed 204 newborns. Fifty-seven of them (28%) had a significant severity, that is to say SNAP II > 10. These high-severity patients had an increased length of hospital stay, higher mortality risk, and greater use of resources such as Mechanical Ventilation. There were no significant differences in weight achieved by discharge, nor in the timing and escalation of the oral feeding when comparing newborns with a SNAP II less than 10 points. For SNAP II > 10, the positive predictive for mortality is 23%, and their negative predictive value is 90%. 

Conclusions: Illness severity for newborns can be quantified easily using a scale like the SNAP II. Such scores allow for risk-adjusted comparisons of outcomes among different NICUs. The quantitative scoring allows identification of newborns with greater severity, a group that, in every NICU, tends to have longer hospital stays, an increased mortality risk, and greater demand for mechanical ventilation.