Aplicação dos índices de gravidade de doença NTISS e SNAP-PE II para avaliar o risco de mortalidade em neonatos prematuros

Abstract

Introduction: Premature newborns require intensive care due to the high risk of mortality and morbidity. Appropriate treatment in the Neonatal Intensive Care Unit can reduce these risks. The Neonatal Therapeutic Intervention Scoring System (NTISS) severity scores, based on the technologies used by patients, and the Score for Neonatal Acute Physiology Perinatal Extension II (SNAP PE II), based on patients’ clinical analyses, are used to indicate the severity of diseases in neonates. In intensive care. Objective: To verify and compare the effectiveness of the NTISS and SNAP PE II scores in assessing the risk of mortality in preterm newborns admitted in the NICU of a Public Tertiary Hospital, located in Curitiba, Brazil. Analyze the intensity of technologies used in the first 24 hours of PTNBs’ lives. Methodology: Retrospective, cross-sectional study, through the analysis of secondary data, with an analytical approach, which collected data from the medical records of premature infants hospitalized from March 2019 to March 2021. Calculate the 24-hour NTISS and SNAP PE II scores. 12 hours after birth, evaluate and compare the predictive power of mortality of both. The inclusion criteria were all premature babies, admitted to the NICU with a gestational age of less than 37 weeks, born in the institution and being admitted to the institution during the first 24 hours of life, whose main pathology was prematurity. Results: a total of 319 newborns were included in this study, 26 (8.2%) patients died. Mean and median length of stay were 31 and 19 days, respectively. The analysis of the Receiver Operating Characteristic (ROC) curve to predict mortality using the NTISS score obtained an area under the curve (AUC) of 0.82 (95% CI) with a cutoff point of 18, with 80.8% and 73.1 % sensitivity and specificity respectively; the SNAPE PE II score obtained an area under the curve (AUC) of 0.89 (95% CI) with a cutoff point of 26, with 88.5% and 83.9% sensitivity and specificity respectively. There was no significant difference between the accuracy in predicting death of both scores (p=0.120). Conclusion: Both NTISS and SNAPPE II scores were found to be effective tools for predicting neonatal death among preterm infants. SNAPPE II showed greater accuracy compared to NTISS, but without significant difference (p=120).