Early postnatal illness severity scores predict neurodevelopmental impairments at 10 years of age in children born extremely preterm

Abstract

Introduction-A neonatal illness severity score, The Score for Neonatal Acute Physiology-II (SNAP-II), predicts neurodevelopmental impairments at two years of age among children born extremely preterm. We sought to evaluate to what extent SNAP-II is predictive of cognitive and other neurodevelopmental impairments at 10 years of age.

‘Does ________ predict neurodevelopmental impairment in former preterm infants?’ Is this the right question to be asked?

“…While the SNAP score correlates well with mortality, nursing workload and length of stay, the complexity due to the large number of data elements led the investigator group to develop more user friendly versions, such as SNAP-II and SNAP-perinatal extension. 7 These observations by Logan et al 1 are informative and help build on the ELGAN study investigators' previous work looking at the association between versions of the SNAP score and mortality, 8 and brain injury in the NICU/neurodevelopment at 2 years of age. 9 While all three SNAP studies in the ELGAN cohort perform a multivariate analysis adjusting for multiple confounders, the further one gets from the event (that is, the first 12 to 24 h of birth), the more challenging it is to make the link along the causal pathway between the predictor (SNAP-II) and outcomes, which the authors acknowledge as a limitation.…”

“…Not surprisingly, the authors found that a high SNAP-II score in the first 12 h of life is associated with an increased risk of neurodevelopmental and social issues at 10 years of age. 1 The authors offer one of the four possible explanations for their findings. The first two describe that physiologic derangements early in life are on the causal pathway to brain injury, as well as other preterm morbidities (for example, sepsis, chronic lung disease (CLD), and so on), and are thus predictors of neurodevelopment.…”

“…In an article in this journal, Logan et al 1 help to inform a piece of the outcomes prediction puzzle as they report on the potential link between a composite of physiologic markers in the neonate in the first 12 h of life (score for neonatal acute physiology II (SNAP-II)) and multifaceted neuropscyhosocial outcomes at 10 years of age in the Extremely Low Gestational Age Newborn (ELGAN) study. 1 The ELGAN study represents a prospective multicenter group of infants born at o28 weeks between the years 2002 to 2004, with prospectively planned neurodevelopmental assessments at multiple time points.…”

“…1 The ELGAN study represents a prospective multicenter group of infants born at o28 weeks between the years 2002 to 2004, with prospectively planned neurodevelopmental assessments at multiple time points. 2 With the original sample size of 1506, the investigators were able to assess nearly 900 children at 10 years of age.…”

“…2 With the original sample size of 1506, the investigators were able to assess nearly 900 children at 10 years of age. 1 This remarkable cohort has helped to inform some of our understanding of the pathophysiology associated with brain injury in ELGANs, as well as provide insight into the long-term outcomes, which are often lacking in clinical trials. Not surprisingly, the authors found that a high SNAP-II score in the first 12 h of life is associated with an increased risk of neurodevelopmental and social issues at 10 years of age.…”