Primary hemostasis in neonates with thrombocytopenia.

OBJECTIVE: To evaluate the relationship between platelet counts and the platelet function analyzer-100 closure times (CTs) in neonates with thrombocytopenia, and to determine what other factors significantly affect CTs. STUDY DESIGN: In a single institution prospective cross-sectional study, blood samples from neonates with platelet counts <150 × 10(9)/L were tested on the platelet function analyzer-100 with CT-collagen/epinephrine (CT-Epi) and CT-collagen/adenosine diphosphate (CT-ADP) cartridges. RESULTS: The mean platelet count was 95 ± 28 × 10(9)/L for 48 infants with a mean gestational age 30.9 ± 5.3 weeks and median postnatal age of 5 (3-18) days. No association was evident between CT-Epi and platelet count. However, the CT-ADP was prolonged in many (but not all) infants with platelet counts <90 × 10(9)/L. Among infants <32 weeks gestational age, we found a moderate negative correlation between CT-ADP and platelet count (r = -0.54, P = .0045). The negative correlation was strongest in infants <32 weeks and <10 days old (r = -0.8, P = .0017). Other variables examined (hematocrit, infection, Score of Neonatal Acute Physiology II) did not have a significant effect on CT-ADP in a linear regression model. CONCLUSIONS: Platelet counts <90 × 10(9)/L are associated with prolonged CT-ADP times in some but not all infants. Gestational and postnatal age-related differences in platelet function account for some of this variability. The predictive value of CT-ADP on neonatal bleeding risk remains to be studied.

SNAP II index: an alternative to the COMFORT scale in assessing the level of sedation in mechanically ventilated pediatric patients.

Sedation monitoring is essential in pediatric patients on ventilatory support to achieve comfort and safety. The COMFORT scale was designed and validated to assess the level of sedation in intubated pediatric patients. However, it remains unreliable in pharmacologically paralyzed patients. The SNAP II index is calculated using an algorithm that incorporates high-frequency (80-420 Hz) electroencephalogram (EEG) components, known to be useful in discriminating between awake and unconscious states, unlike other measurements that only include low-frequency EEG segments such as the bispectral index score. Previous studies suggested that the SNAP II index is a reliable and sensitive indicator of the level of consciousness in adult patients. Despite its potential, no data are currently available in the pediatric critically ill population on ventilatory support. This is the first pilot study assessing the potential application of the SNAP II index in critically ill pediatric patients by comparing it to the commonly used COMFORT scale.

Diagnostic and prognostic values of miR181b-5p and miR21-5p for neonatal sepsis risk and their link to SNAP II score and disease mortality.

Background: Neonatal sepsis is a lethal syndrome that necessitates prompt treatment to avoid disease complications. As a result, biomarkers that may either differentiate sepsis early or predict the outcome of sepsis are essential. Aim: The goal of this research was to find out the clinical weight of using miR181b-5p and miR21-5p expression levels as diagnostic and prognostic new genetic markers for neonatal sepsis. Method: A total of 60 neonates with sepsis and 60 healthy neonates were involved in this study. Laboratory tests include complete blood count (CBC), random blood sugar (RBS), arterial blood gases (ABG), and serum C-reactive protein (CRP). Neonates with sepsis were assessed by the Score for Neonatal Acute Physiology II (SNAP II). The serum fold changes of the target miRNAs were determined using qRT-PCR and the 2-ΔΔCt equation. Results: The relative serum level of miR181b-5p was [ median (IQR) = 0.2509 (0.0009-4.11)] and for miR21-5p was [median (IQR) = 0.07 (0.007-7.16)] which were significantly downregulated in patients with neonatal sepsis compared to controls (p < 0.001 each). There was a strong significant positive correlation between miR181b-5p and miR21-5p with r = 0.718 and p < 0.001. MiR181b-5p and miR21-5p were significantly negatively correlated with total leucocytic count (TLC), lymphocytic count, and CRP. While they were both positively correlated to the SNAP II score. Obvious association between higher expressions of target genes and higher SNAP II score groups. After a following-up period, twenty-two (36.7%) neonates died, while 38 (63.3%) of the babies became better and were released from the hospital. We reported that miR-181-5p, miR21-5p, SNAP II score and CRP were significantly higher in non-survivors than survivors. Only miR181b-5p, miR21-5p, and SNAP II were predictive factors of septic mortality. Conclusion: MiR181b-5p and miR21-5p are diagnostic and prognostic biomarkers of neonatal sepsis.

Post-transport TOPS score as a predictive marker of mortality among transported neonates and its comparative analysis with SNAP-II PE.

Aim: Multiple parameters are available to predict the outcome of critically sick neonates admitted in neonatal intensive care unit (NICU). Main aim of the study is to validate the role of TOPS, especially the post-transport TOPS score as a simplified assessment of neonatal acute physiology in predicting mortality among transported neonates admitted at level III NICU. Also, to compare the efficiency of post transport TOPS score with SNAP II PE in predicting mortality. Methods: A prospective study carried out with 85 neonates transported from various primary health care centres to level III NICU. Physiological status of the neonates was assessed with the help of pre and post transport TOPS scores. Post-transport TOPS score was recorded immediately after the admission and SNAP II PE within 24 h of admission at level III NICU. Receiver operating characteristics analysis was performed to observe the mortality prediction efficiency of TOPS score and was compared with SNAP II PE. Results: 64 neonates were died due to asphyxia and preterm birth (32%) related complications. Strong significant association with the mortality rate was found between the total post transport TOPS score (0.001) and SNAP II PE (0.003). The AUC, sensitivity and specificity of post transport TOPS score for a cut-off value ≤7 were 0.900, 87.5% and 80% and significant (<0.001) and for SNAP II PE for a cut-off value >12 were 0.913, 75.5% and 100% and is significant (<0.001). Conclusion: TOPS score, especially the post transport TOPS score has an equally good prediction capacity of mortality similar like SNAP II PE among mobilised critically ill neonates. Hence, the TOPS score can be used as a simple and effective method to predict mortality risk among transported neonates immediately after admission at level III NICU.

Utilization of SNAP II and SNAPPE II Scores for Predicting the Mortality Rate Among a Cohort of Iranian Newborns.

BACKGROUND: The present study was conducted to determine the utility of Score for Neonatal Acute Physiology II (SNAP II) and Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE II) scoring systems as predictors of neonatal mortality rate, and to compare the predictive value of these two methods. METHODS: In this prospective study data were gathered from infants admitted to the neonatal intensive care unit (NICU) of Imam Hossein Medical Center, Tehran, Iran, from March 2015 to December 2015. In addition to demographic data, Apgar score at 5 minutes after birth, initial and final diagnosis, SNAP II, and SNAPPE II were recorded within 24 hours after admission to the NICU. RESULTS: One hundred ninety-one newborn infants entered into the study. Birth weight (2555 ± 722 g in survival group versus 1588 ± 860 g in expired group, P<0.001), and Apgar score more than 7 at 5 minutes after birth (99.4% in survival group versus 57.1% in expired group, P<0.001) were significantly related to the mortality rate. By analyzing the data using logistic regression, it was found that SNAP II (area under the curve [AUC] = 0.992; 95% CI: 0.98-1) and SNAPPE II (AUC = 0.994; 95% CI: 0.984-1)had better value for predicting the patients' survival compared to Apgar score at 5 minutes after birth (AUC = 0.711; 95% CI: 0.568-0.855). There was no statistically significant difference in predictive value of SNAP II and SNAPPE II methods (P>0.99). CONCLUSION: According to our findings SNAP II and SNAPPE II are useful tools in predicting the mortality rate among Iranian neonates admitted to NICU. Although there was no significant difference between SNAP II and SNAPPE II, both methods had a much better predictive value compared to Apgar score at 5 minutes after birth.

A Prospective, Multicenter, Single-Blind Study Assessing Indices of SNAP II Versus BIS VISTA on Surgical Patients Undergoing General Anesthesia.

BACKGROUND: Traditionally, anesthesiologists have relied on nonspecific subjective and objective physical signs to assess patients' comfort level and depth of anesthesia. Commercial development of electrical monitors, which use low- and high-frequency electroencephalogram (EEG) signals, have been developed to enhance the assessment of patients' level of consciousness. Multiple studies have shown that monitoring patients' consciousness levels can help in reducing drug consumption, anesthesia-related adverse events, and recovery time. This clinical study will provide information by simultaneously comparing the performance of the SNAP II (a single-channel EEG device) and the bispectral index (BIS) VISTA (a dual-channel EEG device) by assessing their efficacy in monitoring different anesthetic states in patients undergoing general anesthesia. OBJECTIVE: The primary objective of this study is to establish the range of index values for the SNAP II corresponding to each anesthetic state (preinduction, loss of response, maintenance, first purposeful response, and extubation). The secondary objectives will assess the range of index values for BIS VISTA corresponding to each anesthetic state compared to published BIS VISTA range information, and estimate the area under the curve, sensitivity, and specificity for both devices. METHODS: This is a multicenter, prospective, double-arm, parallel assignment, single-blind study involving patients undergoing elective surgery that requires general anesthesia. The study will include 40 patients and will be conducted at the following sites: The Ohio State University Medical Center (Columbus, OH); Northwestern University Prentice Women's Hospital (Chicago, IL); and University of Miami Jackson Memorial Hospital (Miami, FL). The study will assess the predictive value of SNAP II versus BIS VISTA indices at various anesthetic states in patients undergoing general anesthesia (preinduction, loss of response, maintenance, first purposeful response, and extubation). The SNAP II and BIS VISTA electrode arrays will be placed on the patient's forehead on opposite sides. The hemisphere location for both devices' electrodes will be equally alternated among the patient population. The index values for both devices will be recorded and correlated with the scorings received by performing the Modified Observer's Assessment of Alertness and Sedation and the American Society of Anesthesiologists Continuum of Depth of Sedation, at different stages of anesthesia. RESULTS: Enrollment for this study has been completed and statistical data analyses are currently underway. CONCLUSIONS: The results of this trial will provide information that will simultaneously compare the performance of SNAP II and BIS VISTA devices, with regards to monitoring different anesthesia states among patients. CLINICALTRIAL: Clinicaltrials.gov NCT00829803; https://clinicaltrials.gov/ct2/show/NCT00829803 (Archived by WebCite at http://www.webcitation.org/6nmyi8YKO).

First 24-h SNAP-II score and highest PaCO2 predict the need for ECMO in congenital diaphragmatic hernia.

BACKGROUND/PURPOSE: Early clinical predictors for the use of ECMO in patients with congenital diaphragmatic hernia (CDH) are lacking. We sought to evaluate the first 24-h SNAP-II score and highest PaCO2 as predictors of ECMO support and in-hospital mortality in neonates with CDH. METHODS: Retrospective review of 47 consecutive neonates with CDH admitted to our institution from January 2007 to December 2010 was performed. Covariates of ECMO use including SNAP-II score and highest PaCO2 within the first 24 h of NICU admission were evaluated. RESULTS: Of the 47 infants in this study, 24 patients were supported with ECMO. The ECMO group had a higher incidence of pulmonary hypertension, higher PaCO2, and higher 24-h SNAP-II scores. Only the SNAP-II score and not highest PaCO2 predicted mortality following multivariate adjustment. CONCLUSIONS: The first 24-h SNAP-II score and highest PaCO2 may provide some prognostic value in identifying neonates who undergo ECMO support; however neither measure was independently associated with the use of therapy. Only the SNAP-II score was associated with in-hospital mortality following multivariate adjustment. Additional study is needed to validate these results in a larger data set.

Comparación de escalas de predicción mortalidad neonatal (crib, crib ii, snap ii, snappe ii) entre recién nacidos prematuros y a término / Comparison of neonatal mortality prediction scales (crib, crib ii, snap ii, snappe ii) between preterm and full term infants

Objetivo: Este artículo compara 4 escalas de predicción de mortalidad y gravedad de la enfermedad (CRIB, CRIB II, SNAPPE, SNAPPE II) en recién nacidos prematuros y a términos, ingresados a las unidades de cuidaos intensivos neonatales (UCIN) para determinar cuál de ellas, tiene mayor discriminación pronostica. Métodos: es un estudio transversal, observacional, multicéntrico para comparar varias escalas de predicción de mortalidad y de la enfermedad. Se recolectaron datos de 227 recién nacidos ingresados a las UCIN de 4 hospitales desde julio a diciembre del 2018. Evaluamos las escalas CRIB, CRIB II, SNAPII y SNAP-PE score en recién nacidos prematuros y a término. El área bajo la curva (ROC) fue usada para evaluar y comparar los resultados de predicción de mortalidad y morbilidad. Resultados: Un total of 227 recién nacidos fueron evaluados (media CRIB: 7,81±3,52 media CRIB-II: 11,96±3,91; media SNAP-II: 34,99±16,83, SNAPPE II: 14,61±13,30). Se evidenció una mayor discriminación para las escalas CRIB II y CRIB en relación con SNAP-II y SNAPP II (AUC 0.94 y 0.93 vs 0.86 y 0,77). Además de cada puntuación, varias variables influyeron significativamente en la supervivencia en los modelos de regresión logística. Conclusiones: Todas las escalas de predicción de mortalidad y de gravedad de la enfermedad sirven para utilizarse en las UCIN estudiadas, siendo la escala CRIB II la de mejor rendimiento para aplicarse en nuestro medio.

Objective: This article compares 4 scales of prediction of mortality and disease severity (CRIB, CRIB II, SNAPPE, SNAPPE II) in preterm and term new borns admitted to neonatal intensive care units (NICU) to determine which of them has greater forecast discrimination. Methods: it is a cross-sectional, observational, multicenter study that compares several mortality and disease prediction scales. Data were collected from 227 newborns admitted to the NICU of 4 hospitals from July to December 2018. We evaluated the CRIB, CRIB II, SNAPII and SNAP-PE score scales in preterm and full term infants. The area under the curve (ROC) was used to evaluate and compare the prediction results of mortality and morbidity. Results: A total of 227 newborns were evaluated (mean CRIB: 7.81 ± 3.52 mean CRIB-II: 11.96 ± 3.91, average SNAP-II: 34.99 ± 16.83, SNAPPE II: 14.61 ± 13.30). There was evidence of greater discrimination for the CRIB II and CRIB scales in relation to SNAP-II and SNAPP II (AUC 0.94 and 0.93 vs 0.86 and 0.77). In addition to each score, several variables significantly influenced survival in the logistic regression models. Conclusions: All the prediction scales of mortality and severity of the disease serve to be used in the studied NICUs, being the CRIB II scale the best performance to apply in our environment.