Predicting deaths in a resource-limited neonatal intensive care unit in Nepal

Background: This study aimed to determine whether the Neonatal Acute Physiology (SNAP) scoring system (SNAP II) and with perinatal extension (SNAP II PE) can be used to predict neonatal deaths in a resourcelimited neonatal intensive care unit in Nepal. Methods: A prospective observational study was conducted in a neonatal intensive care unit (NICU) of Kanti Children's Hospital in Kathmandu, Nepal. Data required for the SNAP II and SNAP II PE scores were collected. The relationships between the SNAP II and SNAP II PE scores and neonatal mortality were analyzed. Results: There were 135 neonates admitted during the 6 month study period, of whom 126 met the inclusion criteria. Of these 126 neonates, 29 (23.0%) died. Mortality was 83% (5/6) when SNAP II was >40, and 66.7% (6/9) when SNAP II PE was >50. A SNAP II score of >= 12 had a sensitivity of 75.9%, and specificity of 73.2% for predicting mortality, and a SNAP II PE score of >= 14 had a sensitivity of 82.8% and specificity of 67.0% for it. Conclusions: SNAP II and SNAP II PE scoring of neonates can be used to predict prognosis of neonates in resource-limited NICUs in Nepal.