{
    "abstract": "The mortality of neonates with congenital diaphragmatic hernia (CDH) ranges between 20 and 40% even in specialized high-volume centers. The Score for Neonatal Acute Physiology-II (SNAP-II Score) could facilitate the decision about supportive therapies in CDH newborns.\nThe SNAP-II score consists of the variables arterial blood pressure, pH, PaO\n101 CDH newborns treated in our institution between 2009 and 2017 were included in the study. A SNAP-II score \u2265 28 was calculated as cutoff for predicting mortality (AUC 0.876; 95% CI: 0.795-0.957). The mortality rate was 52.9% with a SNAP-II score \u2265 28, and 5.9% with a SNAP-II score<28. Sensitivity and specificity for predicting mortality was 81.8 and 79.7%, the negative predicting value (NPV) was 94.0%, the positive predicting value (PPV) 52.9%. The optimal cutoff for predicting ECMO was \u2265 22 (AUC 0.895; 95% CI: 0.836-0.954). Sensitivity and specificity for predicting ECMO therapy was 90.7, and 63.8%, the NPV was 90.2%, and the PPV was 65% respectively. The SNAP-II score was independently associated with mortality [OR 1.126 (95% CI: 1.050-1.207)] and the need for ECMO therapy [OR 1.243 (95% CI: 1.106-1.397)].\nThe SNAP-II score is strongly associated with mortality and the need for ECMO therapy in CDH newborns and should be implemented in the risk stratification of these infants.\nDie angeborene Zwerchfellhernie (CDH) geh\u00f6rt mit einer Mortalit\u00e4t von 20\u201335% zu den schwerwiegendsten Fehlbildungen bei Neugeborenen. Der \u201eScore for Neonatal Acute Physiology-II (SNAP-II Score)\u201c k\u00f6nnte bei Neonaten mit CDH helfen eine Entscheidung \u00fcber weiterf\u00fchrende Therapien zu treffen.\nDer SNAP-II Score umfasst die Variablen Blutdruck, Temperatur, PaO2:FiO2, pH, Diurese und Vorhandensein zerebraler Anfallsaktivit\u00e4t. Der SNAP-II Score wurde im Alter von 12 Std. berechnet.\nEingeschlossen wurden 101 Neonaten mit CDH, die zwischen 2009 und 2017 in unserer Klinik behandelt wurden. Die Mortalit\u00e4t betrug 21,8, 39,6% erhielten eine ECMO-Therapie. Bzgl. Der Pr\u00e4diktion Mortalit\u00e4t wurde ein Grenzwert von 28 berechnet (AUC 0,876; 95% CI: 0,795\u20130,957). Die Mortalit\u00e4t lag bei einem SNAP-II score \u2265 28 bei 52,9% und bei einem Score<28 bei 5,9%. Sensitivit\u00e4t und Spezifit\u00e4t betrugen 94,4 bzw. 83,6%, der positive pr\u00e4diktive Wert (PPV) 63% und der negative pr\u00e4diktive Wert (NPV) 98,1%. Der Grenzwert zur Pr\u00e4diktion einer ECMO-Therapie war 22 (AUC 0,895; 95% CI: 0,836\u20130,954). Die ECMO-Rate f\u00fcr einen SNAP-II score \u2265 22 war 65 bzw. 9,8% bei<22. Sensitivit\u00e4t und Spezifit\u00e4t 82,1 bzw. 68,6%, PPV 59%, NPV 87,5%. Der SNAP-II score war unabh\u00e4ngig mit dem Versterben [OR 1,126 (95% CI: 1,050\u20131,207)] und der Notwendigkeit einer ECMO-Therapie [OR 1,243 (95% CI: 1,106\u20131,397)] assoziiert.\nMittels SNAP-II Score im Alter von 12 Stunden l\u00e4sst sich eine suffiziente prognostische Einsch\u00e4tzung bei CDH-Neugeborenen durchf\u00fchren.",
    "authors": [
        {
            "affiliation": "Department of Neonatology and Pediatric Critical Care Medicine, University Children's Hospital, Bonn, Germany.",
            "firstname": "Florian",
            "initials": "F",
            "lastname": "Kipfmueller"
        },
        {
            "affiliation": "Department of Neonatology and Pediatric Critical Care Medicine, University Children's Hospital, Bonn, Germany.",
            "firstname": "Lukas",
            "initials": "L",
            "lastname": "Schroeder"
        },
        {
            "affiliation": "Department of Neonatology and Pediatric Critical Care Medicine, University Children's Hospital, Bonn, Germany.",
            "firstname": "Tamene",
            "initials": "T",
            "lastname": "Melaku"
        },
        {
            "affiliation": "Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Germany.",
            "firstname": "Annegret",
            "initials": "A",
            "lastname": "Geipel"
        },
        {
            "affiliation": "Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Germany.",
            "firstname": "Christoph",
            "initials": "C",
            "lastname": "Berg"
        },
        {
            "affiliation": "Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Germany.",
            "firstname": "Ulrich",
            "initials": "U",
            "lastname": "Gembruch"
        },
        {
            "affiliation": "Department of Pediatric Surgery, University Hospital Bonn, Germany.",
            "firstname": "Andreas",
            "initials": "A",
            "lastname": "Heydweiller"
        },
        {
            "affiliation": "Department of Pediatric Surgery, University Hospital Bonn, Germany.",
            "firstname": "Charlotte",
            "initials": "C",
            "lastname": "Bendixen"
        },
        {
            "affiliation": "Department of Neonatology and Pediatric Critical Care Medicine, University Children's Hospital, Bonn, Germany.",
            "firstname": "Heiko",
            "initials": "H",
            "lastname": "Reutter"
        },
        {
            "affiliation": "Department of Neonatology and Pediatric Critical Care Medicine, University Children's Hospital, Bonn, Germany.",
            "firstname": "Andreas",
            "initials": "A",
            "lastname": "M\u00fcller"
        }
    ],
    "conclusions": "The SNAP-II score is strongly associated with mortality and the need for ECMO therapy in CDH newborns and should be implemented in the risk stratification of these infants.",
    "copyrights": "\u00a9 Georg Thieme Verlag KG Stuttgart \u00b7 New York.\n\u00a9 Georg Thieme Verlag KG Stuttgart \u00b7 New York.",
    "doi": "10.1055/a-1009-6671",
    "journal": "Klinische Padiatrie",
    "keywords": [],
    "methods": null,
    "publication_date": "2019-10-01",
    "pubmed_id": "31569261",
    "results": "101 CDH newborns treated in our institution between 2009 and 2017 were included in the study. A SNAP-II score \u2265 28 was calculated as cutoff for predicting mortality (AUC 0.876; 95% CI: 0.795-0.957). The mortality rate was 52.9% with a SNAP-II score \u2265 28, and 5.9% with a SNAP-II score<28. Sensitivity and specificity for predicting mortality was 81.8 and 79.7%, the negative predicting value (NPV) was 94.0%, the positive predicting value (PPV) 52.9%. The optimal cutoff for predicting ECMO was \u2265 22 (AUC 0.895; 95% CI: 0.836-0.954). Sensitivity and specificity for predicting ECMO therapy was 90.7, and 63.8%, the NPV was 90.2%, and the PPV was 65% respectively. The SNAP-II score was independently associated with mortality [OR 1.126 (95% CI: 1.050-1.207)] and the need for ECMO therapy [OR 1.243 (95% CI: 1.106-1.397)].",
    "title": "Prediction of ECMO and Mortality in Neonates with Congenital Diaphragmatic Hernia Using the SNAP-II Score.",
    "xml": "<Element 'PubmedArticle' at 0x7885062f2570>"
}