Comparison of SNAPPE II and the Extended Sick Neonate Score for early prediction of mortality in inborn neonates: a prospective cohort study
- 1Department of Pediatrics, Faculty of Medicine, Menoufia University, Shiben Elkom, Menoufia, Egypt
- 2Department of Pediatrics, Ministry of Health and Population, Shiben Elkom, Menoufia, Egypt
Abstract
Background: Early identification of critically ill neonates at high risk of death is essential for optimising clinical management and resource allocation in neonatal intensive care units (NICUs). Several illness severity scores have been developed; however, many require laboratory investigations that may limit their applicability in resource-constrained settings. We aimed to compare the predictive performance of the Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE II) and the Extended Sick Neonate Score (ESNS) for early prediction of in-hospital mortality among neonates admitted to a tertiary NICU.
Methods: This prospective cohort study included 1200 eligible neonates admitted to the NICU of Menoufia University Hospital, Egypt, between March 2022 and June 2025. SNAPPE II and ESNS were calculated within the first 12 hours after admission by trained physicians. The primary outcome was in-hospital mortality. The predictive performance of both scores was evaluated using receiver operating characteristic (ROC) curve analysis, and diagnostic indices including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.
Results: Of the 1200 enrolled neonates, 360 (30.0%) died during hospitalisation. Both scoring systems demonstrated excellent discrimination for mortality prediction. ESNS showed comparable performance, with an area under the ROC curve (AUC) of 0.947 (95% CI 0.91 to 0.98), sensitivity of 91.7%, specificity of 77.8%, PPV of 80.0% and NPV of 90.6% at the optimal cut-off value. SNAPPE II achieved an AUC of 0.918 (95% CI 0.85 to 0.98), sensitivity of 85.7%, specificity of 76.1%, PPV of 76.9% and NPV of 87.6%.
Conclusions: Both SNAPPE II and ESNS demonstrated strong predictive performance for in-hospital mortality. Relying solely on immediate clinical parameters, ESNS offers a simpler, low-cost practical bedside tool for early prediction of neonatal mortality on NICU admission, particularly in resource-limited settings.
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BibTeX
@article{elsayed2026comparison,
title = {{Comparison of SNAPPE II and the Extended Sick Neonate Score for early prediction of mortality in inborn neonates: a prospective cohort study}},
author = {Hanan Mostafa Elsayed and Fady Mohamed Elgendy and Hesham Al-Hussein Serafy and Radwa Mohamed Abdel-Hakeem},
journal = {BMJ Paediatrics Open},
year = {2026},
month = oct,
doi = {10.1136/bmjpo-2026-005201},
url = {https://doi.org/10.1136/bmjpo-2026-005201},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Comparison of SNAPPE II and the Extended Sick Neonate Score for early prediction of mortality in inborn neonates: a prospective cohort study
AU - Hanan Mostafa Elsayed
AU - Fady Mohamed Elgendy
AU - Hesham Al-Hussein Serafy
AU - Radwa Mohamed Abdel-Hakeem
PY - 2026
DA - 2026/10/31
JO - BMJ Paediatrics Open
DO - 10.1136/bmjpo-2026-005201
UR - https://doi.org/10.1136/bmjpo-2026-005201
AB - Background: Early identification of critically ill neonates at high risk of death is essential for optimising clinical management and resource allocation in neonatal intensive care units (NICUs). Several illness severity scores have been developed; however, many require laboratory investigations that may limit their applicability in resource-constrained settings. We aimed to compare the predictive performance of the Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE II) and the Extended Sick Neonate Score (ESNS) for early prediction of in-hospital mortality among neonates admitted to a tertiary NICU. Methods: This prospective cohort study included 1200 eligible neonates admitted to the NICU of Menoufia University Hospital, Egypt, between March 2022 and June 2025. SNAPPE II and ESNS were calculated within the first 12 hours after admission by trained physicians. The primary outcome was in-hospital mortality. The predictive performance of both scores was evaluated using receiver operating characteristic (ROC) curve analysis, and diagnostic indices including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: Of the 1200 enrolled neonates, 360 (30.0%) died during hospitalisation. Both scoring systems demonstrated excellent discrimination for mortality prediction. ESNS showed comparable performance, with an area under the ROC curve (AUC) of 0.947 (95% CI 0.91 to 0.98), sensitivity of 91.7%, specificity of 77.8%, PPV of 80.0% and NPV of 90.6% at the optimal cut-off value. SNAPPE II achieved an AUC of 0.918 (95% CI 0.85 to 0.98), sensitivity of 85.7%, specificity of 76.1%, PPV of 76.9% and NPV of 87.6%. Conclusions: Both SNAPPE II and ESNS demonstrated strong predictive performance for in-hospital mortality. Relying solely on immediate clinical parameters, ESNS offers a simpler, low-cost practical bedside tool for early prediction of neonatal mortality on NICU admission, particularly in resource-limited settings.
SN - 2399-9772
ER -