{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T21:57:14Z","timestamp":1773093434300,"version":"3.50.1"},"reference-count":12,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,11,1]]},"abstract":"<jats:p>BACKGROUND: Illness severity scores predict death among infants admitted to NICUs. We know of no study limited to a population defined by an extremely low gestational age.<\/jats:p><jats:p>METHODS: A total of 1467 infants born before the 28th postmenstrual week at 14 institutions were given Score for Neonatal Acute Physiology II (SNAP-II) and Score for Neonatal Acute Physiology Perinatal Extension II (SNAPPE-II) values based on data collected within the first 12 postnatal hours. All deaths in the intensive care nursery were identified.<\/jats:p><jats:p>RESULTS: The rate of death before postnatal day 28 was 13% (interinstitutional range: 7%\u201320%), whereas the overall mortality rate was 18% (8%\u201331%). SNAP-II values, SNAPPE-II values, and mortality rates tended to decrease with increasing gestational age. Even within gestational age strata, however, the risk of death decreased with decreasing SNAP-II and SNAPPE-II values. The positive predictive values of most SNAP-II and SNAPPE-II cutoff levels were close to 30%. In general, institutions' mortality rates increased with the proportions of infants whose SNAP-II values were \u226530.<\/jats:p><jats:p>CONCLUSION: The physiologic instability in the first 12 postnatal hours that is identified by illness severity scores conveys information about the risk of death among infants at the lowest gestational ages.<\/jats:p>","DOI":"10.1542\/peds.2008-3233","type":"journal-article","created":{"date-parts":[[2009,10,26]],"date-time":"2009-10-26T11:32:53Z","timestamp":1256556773000},"page":"e1001-e1006","source":"Crossref","is-referenced-by-count":38,"title":["Interinstitutional Variation in Prediction of Death by SNAP-II and SNAPPE-II Among Extremely Preterm Infants"],"prefix":"10.1542","volume":"124","author":[{"given":"Olaf","family":"Dammann","sequence":"first","affiliation":[{"name":"Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts"},{"name":"Perinatal Infectious Disease Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany"},{"name":"Neuroepidemiology Unit, Children's Hospital Boston, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhavesh","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Baystate Medical Center, Springfield, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Naples","sequence":"additional","affiliation":[{"name":"Division of Neonatology, University of Massachusetts Memorial Health Care, Worcester, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis","family":"Bednarek","sequence":"additional","affiliation":[{"name":"Division of Neonatology, University of Massachusetts Memorial Health Care, Worcester, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Zupancic","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"},{"name":"Department of Pediatrics"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth N.","family":"Allred","sequence":"additional","affiliation":[{"name":"Neuroepidemiology Unit, Children's Hospital Boston, Boston, Massachusetts"},{"name":"Department of Neurology, School of Medicine"},{"name":"Department of Biostatistics, School of Public Health, Harvard University, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Leviton","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the ELGAN Study Investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2009,11,1]]},"reference":[{"key":"2021120905183408200_R1","doi-asserted-by":"crossref","unstructured":"Richardson DK, Phibbs CS, Gray JE, McCormick MC, Workman-Daniels K, Goldmann DA. Birth weight and illness severity: independent predictors of neonatal mortality. Pediatrics.\u20081993;91(5):969\u2013975","DOI":"10.1542\/peds.91.5.969"},{"key":"2021120905183408200_R2","doi-asserted-by":"crossref","unstructured":"Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr.\u20082001;138(1):92\u2013100","DOI":"10.1067\/mpd.2001.109608"},{"key":"2021120905183408200_R3","doi-asserted-by":"crossref","unstructured":"Zupancic JAF, Richardson DK, Horbar JD, et al. Revalidation of the Score for Neonatal Acute Physiology in the Vermont Oxford Network. Pediatrics.\u20082007;119(1). Available at: www.pediatrics.org\/cgi\/content\/full\/119\/1\/e156","DOI":"10.1542\/peds.2005-2957"},{"key":"2021120905183408200_R4","doi-asserted-by":"crossref","unstructured":"Rautonen J, Makela A, Boyd H, Apajasalo M, Pohjavuori M. CRIB and SNAP: assessing the risk of death for preterm neonates. Lancet.\u20081994;343(8908):1272\u20131273","DOI":"10.1016\/S0140-6736(94)92158-X"},{"key":"2021120905183408200_R5","doi-asserted-by":"crossref","unstructured":"Pollack MM, Koch MA, Bartel DA, et al. A comparison of neonatal mortality risk prediction models in very low birth weight infants. Pediatrics.\u20082000;105(5):1051\u20131057","DOI":"10.1542\/peds.105.5.1051"},{"key":"2021120905183408200_R6","doi-asserted-by":"crossref","unstructured":"Gagliardi L, Cavazza A, Brunelli A, et al. Assessing mortality risk in very low birthweight infants: a comparison of CRIB, CRIB-II, and SNAPPE-II. Arch Dis Child Fetal Neonatal Ed.\u20082004;89(5):F419\u2013F422","DOI":"10.1136\/adc.2003.031286"},{"key":"2021120905183408200_R7","doi-asserted-by":"crossref","unstructured":"Akobeng AK. Understanding diagnostic tests 1: sensitivity, specificity and predictive values. Acta Paediatr.\u20082007;96(3):338\u2013341","DOI":"10.1111\/j.1651-2227.2006.00180.x"},{"key":"2021120905183408200_R8","doi-asserted-by":"crossref","unstructured":"Leviton A, Blair E, Dammann O, Allred E. The wealth of information conveyed by gestational age. J Pediatr.\u20082005;146(1):123\u2013127","DOI":"10.1016\/j.jpeds.2004.09.028"},{"key":"2021120905183408200_R9","doi-asserted-by":"crossref","unstructured":"Eleftheriades M, Creatsas G, Nicolaides K. Fetal growth restriction and postnatal development. Ann N Y Acad Sci.\u20082006;1092:319\u2013330","DOI":"10.1196\/annals.1365.047"},{"key":"2021120905183408200_R10","doi-asserted-by":"crossref","unstructured":"Papageorghiou AT, Fratelli N, Leslie K, Bhide A, Thilaganathan B. Outcome of fetuses with antenatally diagnosed short femur. 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