SNAPPE-II Research Suite v5.1

⚠ Clinical Safety Notice — Read Before Use

For NICU severity benchmarking and audit support only.
NOT for individual treatment decisions. NOT to deny or withdraw care.
Interpret only by a trained neonatal clinician.
Clinical condition, gestation, diagnosis & serial examination take precedence over score.
Mortality risk values are population-level estimates, not individual predictions.
Ref: Richardson et al., Pediatrics 2001;108(4):909–916. SNAPPE-II max score = 162.

👶 Patient & Assessment Details

Baby Name / ID

Mother's Name

Admission No.

Ward / NICU Bed

Gestational Age

Birth Weight (g)

Sex *

Provisional Diagnosis

Diagnosis Category

Referring Source

Respiratory Support

Inotrope / Vasopressor

ABG Source / Time

📅 Date of Birth

🕐 Time of Birth

📅 Assessment Date

🕑 Assessment Time

Assessment No.

Time Block

Clinician Name & Designation

Assessment Performed By

Designation

Assessment Verified By

Verification Time

🕐

🆔 Report ID: —

Item Completeness 0 / 9 selected

MAP

Temp

BWT

SGA

APG5

📊 SNAP-II Variables (worst values in first 12 hours)

Mean Blood Pressure (MAP)

Worst MAP in first 12 hrs (mmHg)

—

≥ 30 mmHgNormal range

20–29 mmHgModerate hypotension

< 20 mmHgSevere hypotension

Temperature (Lowest)

Lowest recorded temp in first 12 hrs (°C) — 3 tiers per Richardson 2001

—

> 35.6 °CNormothermia

35.0 – 35.6 °CMild hypothermia

< 35.0 °CSignificant hypothermia

PO₂ / FiO₂ Ratio

Worst ratio in first 12 hrs — max 28 pts if <0.30

—

> 2.49Adequate oxygenation

1.00 – 2.49Mild–moderate hypoxia

0.30 – 0.99Severe hypoxia

< 0.30Critical hypoxia — 28 pts (NOT 16)

Serum pH

Lowest pH in first 12 hrs (from ABG)

—

≥ 7.20Normal-mild acidosis

7.10 – 7.19Moderate acidosis

< 7.10Severe acidosis

Seizures

Multiple seizures in first 12 hrs

—

None or single seizure

Multiple seizures≥2 episodes in 12 hrs

Urine Output

Average ml/kg/hr over first 12 hrs

—

≥ 1.0 ml/kg/hrAdequate

0.1 – 0.9 ml/kg/hrOliguria

< 0.1 ml/kg/hrAnuria

🍼 Perinatal Extension (PE) — 3 Separate Items

Birth Weight

PE Item — 3 tiers per Richardson 2001 · scored separately from SGA

—

≥ 1000 gNot ELBW

750 – 999 gVery low birth weight

< 750 gExtremely low birth weight

Small for Gestational Age (SGA)

PE Item — 12 pts · <10th centile for GA · Independent of item 7

—

Not SGAWeight ≥ 10th centile for gestational age (Fenton 2013 / WHO chart)

SGA — weight < 10th centile for GAFenton 2013 for preterm; WHO 2006 for term. Both = 12 pts.

APGAR at 5 Minutes

PE Item — from delivery record · cutoff <7 per Richardson 2001

—

APGAR ≥ 7Normal vigour at 5 minutes

APGAR < 7 (i.e. 0–6)Depressed at 5 minutes

PaedCare KGH

SNAPPE-II — Neonatal Illness Severity Score

— / 162

—

🆔 Study ID (de-identified)

—

—

Birth Weight

—

Sex

—

Diagnosis

—

Resp. Support

—

Inotropes

—

ABG Source

—

🍼 Age at Assessment

—

Assessment

—

Date & Time

—

🔒 This report is de-identified (study-mode only). No patient name, mother's name, admission number, ward, or clinician identifiers are displayed. Bedside identifiers remain in the input form only and are never shown in any report, export, or dashboard.

📋 Item-wise Score Breakdown (Value → Points)

1. Mean BP (MAP)—

2. Temperature—

3. PO₂/FiO₂ Ratio—

4. Serum pH—

5. Seizures—

6. Urine Output—

7. Birth Weight (PE)—

8. SGA (PE)—

9. APGAR at 5 min (PE)—

TOTAL SNAPPE-II—

Completeness—

📊 SCORE COMPOSITION

SNAP-II Physiologic Score— / 115

Perinatal Extension Score— / 47

SNAPPE-II Total— / 162

—

⚠ BENCHMARKING TOOL ONLY. ① Not an individual prediction. ② Not a treatment-decision tool. ③ Do not use to deny, limit or withdraw care. ④ Clinical judgment supersedes score. Observed mortality values are from the original SNAPPE-II validation cohort only (Richardson DK et al., 2001, n=1,595). ⚠ These mortality figures do not represent current AMC/KGH outcomes.

⚠ WhatsApp / Copy / Print are disabled until this assessment is Saved — a Study ID must exist before any report can be shared.

📸 Screenshot the card above to save as image.

📊 SNAPPE-II Observed Mortality — Richardson et al., Pediatrics 2001

Score Band	Observed Mortality	Risk Category
0 – 9	0.3%	Very Low
10 – 19	1.6%	Low
20 – 29	3.8%	Low-Moderate
30 – 39	7.4%	Moderate
40 – 49	15.7%	High
50 – 59	22.1%	High
60 – 69	32.6%	Very High
70 – 79	38.7%	Very High
≥ 80	66.7%	Extreme

⚠ Population-level benchmarking data only. Not an individual prediction. Do not use to deny, limit or withdraw care. Clinical judgment supersedes score.

📋 Scoring Notes: SNAP-II max = 115 (MAP 19 + Temp 15 + PF 28 + pH 16 + Seizures 19 + UO 18). PE max = 47 (APGAR5 18 + BWT 17 + SGA 12). SNAPPE-II total max = 162.

🔬 SNAP-II vs SNAPPE-II: If perinatal data unavailable, document as SNAP-II only (max 115). An incomplete score must not be used for benchmarking.

📁 Layer 2 — Audit Registry: Tap "Save to Audit" after scoring to add this record to the longitudinal audit registry. Records are stored privately on this device only. Switch to the Audit tab to view, update outcomes, and export.

📋 NICU Research Registry — L3

Total

Complete

Outcomes

Pending

💾 Data stored locally on this device. No patient data is transmitted. Use CSV export in the Research tab for analysis. Recommended: export CSV monthly for backup and research.

🎯 Outcome Tracking Module — L4

📊 Outcomes Entered

🎯 Why outcomes matter: Linking SNAPPE-II scores to actual outcomes (survival, death, LAMA, transfer) creates the dataset for local validation — the first step toward a KGH-specific mortality prediction model. Even 50 paired records create publishable data.

📊 Research Analytics Dashboard — L5

📊

No data yet

Save at least 1 assessment to see analytics.

📤 Research Exports — Standard Dataset

Export the full audit dataset for analysis. All exports are from data saved on this device. No data is sent to any server. (See also the dedicated Exports tab.)

⚠ Audit CSV contains identified patient data — internal audit use only. Do not share externally. Use Research CSV/JSON (De-id) for sharing with statisticians or co-investigators.

📚 Publication Potential — AMC/KGH SNAPPE-II Research

🏆 Primary Research Questions (Cross-Sectional)

SNAPPE-II score distribution among NICU admissions at a tertiary government teaching hospital in South India

Prevalence of high-severity illness (SNAPPE-II ≥ 40) in resource-limited NICU settings

Profile of illness severity by diagnosis category: RDS vs HIE vs Sepsis

Contribution of perinatal factors (SGA, ELBW, low APGAR) to SNAPPE-II score in a government NICU

🔬 Cohort Studies (Requires Outcome Data — Layer 3)

Relationship between SNAPPE-II score at admission and NICU mortality — local validation study

SNAPPE-II vs CRIB-II: comparative validity for mortality prediction in Indian NICU populations

SNAPPE-II score as a predictor of ventilator requirement and CPAP failure

Does SNAPPE-II predict LAMA (left against medical advice) in resource-constrained settings?

📈 Quality Improvement Projects

Audit of SNAPPE-II completeness: feasibility of systematic scoring in a busy government NICU

Tracking mean SNAPPE-II trends as a NICU quality indicator over time

Effect of kangaroo mother care and hypothermia bundle on temperature sub-score trends

🌍 Health Systems Research (LMIC-Specific)

SNAPPE-II feasibility in ABG-limited settings: can SNAP-II (without PE) still predict outcome?

Missing data patterns in SNAPPE-II: implications for scoring in resource-limited NICUs

Benchmarking AMC/KGH NICU severity profile against published Indian NICU cohorts

📋 Target Journals: Indian Pediatrics · Journal of Tropical Pediatrics · Indian Journal of Pediatrics · Acta Paediatrica · Archives of Disease in Childhood — Fetal & Neonatal · BMJ Open · PLOS ONE (for LMIC validation studies)

Feature	SNAPPE-II	CRIB-II
Full name	Score for Neonatal Acute Physiology — Perinatal Extension II	Clinical Risk Index for Babies II
Reference	Richardson DK et al., Pediatrics 2001	Parry G et al., Lancet 2003
Max score	162 (SNAP-II 115 + PE 47)	27
No. of variables	9 (6 physiologic + 3 perinatal)	5 (GA, BWT, sex, congenital anomaly, base excess)
ABG required?	Yes (pH item; SNAP-II possible without)	Yes (base excess)
Assessment window	First 12 hours	First 12 hours
Validated in India?	Limited; needs local validation	Limited; needs local validation
LMIC feasibility	Moderate — ABG, UO, BP monitoring needed	High — GA, BWT, sex, congenital anomaly, 1 ABG
Includes SGA/BWT?	Yes — explicit PE items	Yes — BWT is a core variable
Seizures captured?	Yes — 19 pts for multiple seizures	No
Urine output captured?	Yes — 0 / 5 / 18 pts	No
Temperature captured?	Yes — 0 / 8 / 15 pts	No
Congenital anomaly	Not a standalone item	Yes — binary yes/no item
Primary outcome	NICU mortality risk stratification	NICU mortality risk stratification
Research advantage	Multi-domain physiology + perinatal context; richer dataset for QI	Very simple; can be calculated without ICU monitoring

🔬 Proposed Comparative Study Design — AMC/KGH

Title: Comparative validity of SNAPPE-II and CRIB-II for predicting neonatal mortality in a government teaching hospital NICU in South India — a prospective cohort study

Setting: NICU, King George Hospital / Andhra Medical College, Visakhapatnam
Design: Prospective cohort, consecutive NICU admissions
Sample: n ≥ 100 (80% power, α=0.05, expected mortality ~15–20%)
Primary outcome: NICU mortality (death before discharge)
Secondary: Ventilator requirement, CPAP failure, LAMA, transfer
Analysis: AUROC for SNAPPE-II vs CRIB-II; calibration (Hosmer-Lemeshow); DeLong test for AUROC comparison
Target journal: Indian Pediatrics / Journal of Tropical Pediatrics / BMJ Open

Data collection: Both scores calculable from same admission data. Both apps (SNAPPE-II + CRIB-II) needed. Export CSVs from each → merge by Admission No. → SPSS/R analysis.

⚠ CRIB-II app needed: To implement the full comparative study, a CRIB-II scoring app should be built in the PaedCare KGH suite. The comparison CSV export in the Research tab generates a template linking both scores per patient.

SNAPPE-II Score

⚖ SNAPPE-II vs CRIB-II — Comparative Framework