Validity of the SNAP-II Score in Predicting Neonatal Mortality and Morbidity at a Tertiary Care NICU: A Prospective Observational Study

Introduction: The Neonatal Mortality Rate (NMR) remains high in India despite various advances in neonatal care. A reliable scoring system may help identify sick neonates and facilitate early interventions. The Score for Neonatal Acute Physiology (SNAP)-II scoring system was developed to assess the severity of illness and predict mortality and morbidity among neonates admitted to the Neonatal Intensive Care Unit (NICU). Aim: To validate the SNAP-II scoring system in predicting neonatal outcomes at a tertiary care NICU in Uttar Pradesh. Materials and Methods: A prospective observational study was conducted in the NICU of the Department of Paediatrics at FH Medical College and Hospital, Agra-Etmadpur, Uttar Pradesh, India. A total of 259 neonates aged between 1 and 28 days, who were admitted to the NICU between September 2022 and March 2024, were included in the study after obtaining consent from parents. Physiological parameters were recorded within 12 hours of admission to calculate SNAP-II scores. Neonatal outcomes, including mortality, need for respiratory support, inotropic use, and length of stay in the NICU, were analysed. Statistical analysis included t-tests, chi-square tests, Receiver Operating Characteristics (ROC) curves, and sensitivity-specificity assessments. Results: A total of 259 babies were enrolled, but 32 were excluded from the study (9 expired within 24 hours, and 23 left against medical advice). In the remaining 227 babies, there were 146 (64.3%) males and 81 (35.7%) were females. Most of the babies were preterm 120 (52.9%), while 107 (47.1%) were term. The study found a significant association between higher SNAP-II scores and increased mortality, prolonged NICU stay, and a greater need for respiratory support and inotropes (p<0.001). A SNAP-II cut-off of 46 showed 93.3% sensitivity and 89% specificity for predicting mortality. Individual parameters of SNAP-II did not independently predict outcomes. Conclusion: The SNAP-II scoring system is a reliable tool for early risk stratification in NICUs, facilitating targeted interventions and optimising resources. Its integration into NICU protocols can significantly improve neonatal outcomes.