SNAPPE-II and MDAS scores as predictors for surgical intervention in very low birth weight neonates with necrotizing enterocolitis

Figures & data

Table 1. Variables and their associated points used to calculate SNAPPE-II scores.

Variables	Score points
Mean Blood Pressure (mmHg)
>30	0
20–29	9
<20	19
Lowest Body Temperature (^oF)
>96	0
95–96	8
<95	15
PO2/FiO2 ratio
>2.5	0
1.0–2.49	5
0.3–0.99	16
<0.3	28
Lowest serum pH
>7.2	0
7.1–7.19	7
<7.1	16
Multiple seizures
No	0
Yes	19
Urine output (mL/kg/hr)
>1	0
0.1–0.9	5
<0.1	18
APGAR score
>7	0
<7	18
Birth weight (gm)
>1000	0
750–999	10
<750	17
Small for gestational age
<3^rd Percentile	12

Table 2. Variables and their associated criteria used to calculate MDAS scores.

Variables	Criteria
Blood culture positive	Blood culture positive within 96 h
Acidosis	pH <7.25 or receiving bicarb/Tris-hydroxymethyl aminomethane
Bandemia (I/T > 0.2)	Absolute number of immature neutrophils/total
Sodium (Na) <130 mEq/L	Within last 24 h
Platelets (Plts) <50,000	Platelet count <50,000/mm^3
Blood pressure (required pressors)	Mean Arterial Pressure < gestational age or on any pressors
Neutrophil count <2000	Absolute neutrophil count <2000/mm^3

Each metabolic derangement variable is given a score of one point if patient fulfills the criterion. If patient does not fulfill criteria, a score of zero is given.

Table 3. Maternal and neonatal clinical characteristics.

	Treatment		p-value*
	Surgical NEC Management (n = 20)	Medical NEC Management (n = 44)
Maternal characteristics
Antenatal steroids, n (%)	17 (85.0)	28 (66.7)	.13
Chorioamnionitis, n (%)	3 (15.8)	5 (11.4)	.69
Hypertension, n (%)	5 (26.3)	8 (18.2)	.51
Eclampsia and preeclampsia, n (%)	5 (26.3)	8 (18.6)	.51
Cesarean delivery, n (%)	12 (60.0)	32 (72.7)	.31
Neonatal characteristics
Birth weight, gram, mean (SD)	913.0 (302.4)	860.5 (217.6)	.43
Gestational age, week, mean (SD)	27.4 (2.5)	27.0 (2.0)	.46
Apgar scores at 5 min, median (IQR)	8 (7-9)	7.5 (6.5-8)	.45
Male sex, n (%)	13 (65.0)	17 (38.6)	.0501
Size for gestational age, n (%)			.51
Small for gestational age	5 (25.0)	6 (13.6)
Appropriate for gestational age	15 (75.0)	37 (84.1)
Large for gestational age	0 (0)	1 (2.3)
Patent ductus arteriosus, n (%)	14 (70.0)	28 (63.6)	.64
NSAID therapy, n (%)	4 (20.0)	10 (22.7)	1.00
Feeding breast milk prior to the NEC diagnosis, n (%)	18 (90.0)	40 (90.9)	1.00
Postnatal steroids, n (%)	14 (70.0)	14 (31.8)	.004
Transfusion 24 h prior to the NEC diagnosis, n (%)	3 (15.0)	7 (15.9)	1.00
Corrected gestational age at the time of NEC diagnosis, week, mean (SD)	30.9 (2.5)	31.8 (3.9)	.28
Weight at the time of NEC diagnosis, mean (SD)	1160.9 (282.2)	1356.8 (655.6)	.28

*By two sample t-test/Wilcoxon test for continuous variables and Chi-square test/Fisher’s exact test for categorical variables.

Figure 1. ROC curves for MDAS and SNAPPE-II at NEC diagnosis on surgical vs medical NEC.

Figure 2. ROC curves for MDAS and SNAPPE-II at NEC diagnosis on surgical (without the neonates with pneumoperitoneum) vs medical NEC.

Table 4. SNAPPE-II and MDAS scores at birth and at time of NEC.

	Treatment		p-value*
	Surgical NEC management (n = 20)	Medical NEC management (n = 44)
SNAPPE- II at birth, median (IQR)	25 (8.5–31)	25 (15–41)	.34
MDAS at birth, median (IQR)	1 (0–2)	1 (0–2)	.90
SNAPPE- II at NEC diagnosis, median (IQR)	38 (18.5–69)	19 (10–34.5)	.01
MDAS at NEC diagnosis, median (IQR)	2.5 (1–3)	1 (0–2)	.0004
Number of hours from the NEC diagnosis to the 1st surgical consult/evaluation, median (IQR)	6 (2.5–10)	9 (3–18)	0.18
Number of hours from the NEC diagnosis to surgery, median (IQR)	17.5 (8.5–61.5)	N/A	N/A

*By two sample t-test/Wilcoxon test for continuous variables and Chi-square test/Fisher’s exact test for categorical variables.