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Published online December 11, 2006
PEDIATRICS Vol. 119 No. 1 January 2007, pp. e156-e163 (doi:10.1542/peds.2005-2957)
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ARTICLE

Revalidation of the Score for Neonatal Acute Physiology in the Vermont Oxford Network

John A. F. Zupancic, MD, ScDa,b, Douglas K. Richardson, MD, MBAa,b,{dagger}, Jeffrey D. Horbar, MDc,d, Joseph H. Carpenter, MSc, Shoo K. Lee, MD, PhDe, Gabriel J. Escobar, MDf, Vermont Oxford Network SNAP Pilot Project Participants

a Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
b Division of Newborn Medicine, Harvard Medical School, Boston, Massachusetts
c Vermont Oxford Network, Burlington, Vermont
d Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont
e Integrated Centre for Care Advancement through Research Edmonton (iCare), University of Alberta, Edmonton, Alberta, Canada
f Perinatal Research Unit, Kaiser Permanente Medical Care Program Division of Research, Oakland, California

OBJECTIVES. Our specific objectives were (1) to document the performance of the revised Score for Neonatal Acute Physiology and the revised Score for Neonatal Acute Physiology Perinatal Extension in predicting death in the Vermont Oxford Network, compared with published normative values; (2) to determine whether this performance could be improved through recalibration of the weights for individual score items; (3) to determine the impact of including congenital anomalies in the predictive model; and (4) to compare performance against that of the Vermont Oxford Network risk adjustment, separately and in combination.

METHODS. Fifty-eight Vermont Oxford Network centers collected data prospectively for the revised Score for Neonatal Acute Physiology in the first 12 hours after admission of infants in 2002.

RESULTS. Data were collected for 10469 infants, and analyses were undertaken for 9897 who met inclusion criteria. The median revised Score for Neonatal Acute Physiology was 5, and the mean birth weight was 1951 g. Recalibration of the revised Score for Neonatal Acute Physiology and revised Score for Neonatal Acute Physiology Perinatal Extension resulted in minimal changes in their discriminatory abilities. The Vermont Oxford Network risk adjustment performed similarly, compared with the revised Score for Neonatal Acute Physiology Perinatal Extension.

CONCLUSIONS. Current score performance was similar to that observed previously, which suggests that the revised Score for Neonatal Acute Physiology and revised Score for Neonatal Acute Physiology Perinatal Extension have not decalibrated over the 7 years since the first cohort was assembled, despite advances in neonatal care during that period. Addition of congenital anomalies to the revised Score for Neonatal Acute Physiology Perinatal Extension improved discrimination significantly, particularly for infants with birth weights of >1500 g. The Vermont Oxford Network risk adjustment performed similarly, compared with the revised Score for Neonatal Acute Physiology Perinatal Extension.

Key Words: infant • newborn • predictive value of tests • illness severity

Abbreviations: AUC—area under receiver operating characteristic curve • ROC—receiver operating characteristic • SNAP—Score for Neonatal Acute Physiology • SNAP-II—revised Score for Neonatal Acute Physiology • SNAPPE-II—revised Score for Neonatal Acute Physiology Perinatal Extension • VON—Vermont Oxford Network • VON-RA—Vermont Oxford Network risk adjustment

Accepted Jul 26, 2006.


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