Abstract:

Abstract：Objective　To compare the advantages of critically ill neonates mortality risk prediction between neonatal critical illness score and score for neonatal acute physiology，perinatal extension，Version II （SNAPPE-II） and to research for the better neonatal disease severity scoring system feasible for use in our country. Methods　The 525 neonates，who were in neonatal intensive care unit（NICU） from Jan 2008 to Dec 2008 in the Zhongda Hospital affiliated to Southeast University，were scored by NCIS and SNAPPE-Ⅱ simultaneously.According to the scores the patients were divided into three groups （very critical group， critical group， non-critical group），and mortality rates were compared in each group.At the same time we drew the receiver operating characteristic curve （ROC） and counted out their areas under the ROC curves to observe the specificity and sensitivity of two scoring systems in predicting the risk of death in critically ill neonates. Results　The comparison between NCIS and SNAPPE-Ⅱscore：the differences were not statistically significant in mortality between the non-critical and the very critical subgroups（P > 0.05）； the difference between the two critical subgroups was statistically significant in mortality （P < 0.05）；the area under the ROC curve （AUC）：NCIS 0.934， SNAPPE-Ⅱ0.926. The differences were not statistically significant in AUC between NCIS and SNAPPE-Ⅱ. Conclusion　SNAPPE-Ⅱcan predict mortality risk in critically ill neonates earlier and more accurate and clinical application is easy.SNAPPE-Ⅱshould be used generally. NCIS's ability to distinguish critically ill newborns is better than SNAPPE-II， but cannot guide the clinical decision-making.

Key words: neonatal critical illness score（NCIS）；score for neonatal acute physiology, perinatal extension, Version Ⅱ（SNAPPE-Ⅱ）；mortality risk

摘要：

目的　比较新生儿危重病例评分（NCIS） 与美国新生儿急性生理学评分围产期补充Ⅱ（SNAPPE-Ⅱ）在危重新生儿死亡风险预测方面的优越性，探索适合我国新生儿疾病危重度判断的评分系统。方法　对2008年1-12月入住东南大学附属中大医院新生儿重症监护室（NICU）的525例患儿同时采用NCIS和SNAPPE-Ⅱ两种评分系统进行评分，根据评分将入组病例分为极危重、危重、非危重3组，分别对各组病死率进行比较，并描绘受试者工作特征曲线（ROC），比较ROC曲线下面积（AUC），以观察两种评分系统在预测危重新生儿死亡风险的特异度及灵敏度。结果　非危重组、极危重组中，NCIS评分及SNAPPE-Ⅱ的病死率比较，差异无统计学意义（P > 0.05）；危重组中，两种评分病死率比较，差异有统计学意义（P < 0.05）；AUC分别为NCIS评分0.934，SNAPPE-Ⅱ评分0.926，两组差异无统计学意义（P > 0.05）。结论　NCIS评分对危重新生儿的筛出能力较强，但对临床决策无早期指导作用。SNAPPE-Ⅱ评分能早期、较准确预测患儿死亡风险，临床应用较简便，宜推广使用。

关键词: 新生儿危重病例评分, 新生儿急性生理学评分围产期补充Ⅱ, 死亡风险