PEDIATRICS Vol. 91 No. 3 March 1993, pp. 617-623
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Score for Neonatal Acute Physiology: A Physiologic Severity Index for Neonatal Intensive Care

Douglas K. Richardson MD, MBA1, James E. Gray MD, SM2, Marie C. McCormick MD, ScD1, Kathryn Workman PhD1, and Donald A. Goldmann MD3

1 From the Joint Program in Neonatology (Children's Hospital, Brigham and Women's Hospital, Beth Israel Hospital in Boston), Department of Pediatrics, Harvard Medical School; Department of Maternal and Child Health, Harvard School of Public Health, Boston, MA.
2 From the Joint Program in Neonatology (Children's Hospital, Brigham and Women's Hospital, Beth Israel Hospital in Boston), Department of Pediatrics, Harvard Medical School, Boston, MA.
3 From the Division of Infectious Diseases and Division of Quality Improvement, Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.

The substantial variation in birth weight-adjusted mortality among neonatal intensive care units (NICUs) may reflect differences in population illness severity. Development of an illness severity measure is essential for comparisons of outcomes. The Score for Neonatal Acute Physiology (SNAP) was developed and validated prospectively on 1643 admissions (114 deaths) in three NICUs. SNAP scores the worst physiologic derangements in each organ system in the first 24 hours. SNAP showed little correlation with birth weight and was highly predictive of neonatal mortality even within narrow birth weight strata. It was capable of separating patients into groups with 2 to 20 times higher mortality risk. It also correlated highly with other indicators of severity including nursing workload (r = .59), therapeutic intensity (r = .78), physician estimates of mortality risk (r = .65), and length of stay (R2 = .59). SNAP is an important new tool for NICU research.

Key Words: illness severity scoring • neonatal intensive care • neonatal mortality

Submitted on January 17, 1992
Accepted on October 6, 1992




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