PREDICTIVE ACCURACY OF CRIB-II AND SNAPPE-II SCORES FOR MORTALITY RISK IN PRETERM NEONATES: A CROSS-SECTIONAL VALIDATION STUDY AT BENAZIR BHUTTO HOSPITAL, RAWALPINDI

Predictive Accuracy of CRIB-II and SNAPPE-II in Preterm Mortality

Abstract

Background: Preterm birth is a major contributor to neonatal mortality and long-term neurodevelopmental complications globally, largely due to the immaturity of essential organ systems such as the lungs, brain, gastrointestinal tract, and immune system. 

Objectives: To compare the diagnostic performance of the CRIB-II and SNAPPE-II scoring systems in predicting mortality among preterm neonates.

Methods: It is Cross-sectional validation study conducted at Department of Paediatrics, Benazir Bhutto Hospital, Rawalpindi, from 15th February to 15th May 2025. This study included preterm neonates with a gestational age of less than 32 weeks and a birth weight below 1500 grams, selected through non-probability consecutive sampling. Both CRIB-II and SNAPPE-II scores were calculated within 12 hours of admission according to standard criteria. Mortality risk was classified using cutoffs of ≥8.5 for the CRIB-II and ≥27.5 for the SNAPPE-II. Neonatal outcomes were monitored for 28 days. Diagnostic indicators, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios, and the area under the receiver operating characteristic curve (AUC), were determined.

Results: Of the 122 neonates enrolled, 15 (12.3%) did not survive. The CRIB-II scores correctly identified 11 deaths, with a sensitivity of 73.33%, specificity of 79.44%, PPV of 33.33%, NPV of 95.51%, accuracy of 78.69%, and an AUC of 0.925. SNAPPE-II identified 12 deaths, demonstrating a sensitivity of 80.00%, specificity of 84.11%, PPV of 41.38%, NPV of 96.77%, accuracy of 83.61%, and an AUC of 0.952.

Conclusion: Both scoring systems demonstrated reliable diagnostic value for early mortality prediction in preterm neonates. In this cohort, SNAPPE-II exhibited superior overall performance.