"Score for Neonatal Acute Physiology" (SNAP) dan "Score for Neonatal Acute Physiology Perinatal Extension" (SNAP-PE) sebagai alat duga kematian neonatus di NICU RSUP dr. Kariadi Semarang

Abstract

Background: Critically ill neonates that require intensive care need to be managed effectively and efficiently. Approach to support these supportif care were performed to decrease mortality. SNAP and SNAP-PE were designed to allow objective quantification of severity illness in neonatal intensive care unit, based according to physiology aspects, measures the physiologic de-arrangement of organ systems. Objective: To measure validity of SNAP and SNAP-PE as a tool to access neonatal mortality. Design: Diagnostic test. Location: Neonatal Intensive Care Unit of dr. Kariadi Hospital Semarang (teaching hospital). Subject: Critically ill neonates admitted to the NICU of dr. Kariadi Hospital Semarang, who meet the research criteria such as: age less than 7 days, born at dr. Kariadi Hospital Semarang, without any major congenital anomalies. Method: Measurement of clinical and laboratory examination were done, reflecting the condition of 7 organ systems. Each parameter was accessed according to score, ranged 0 — 5, score beginning at 24 hours from admission at NICU. Analysis: Diagnostic test was done to determine sensitivity (Se), specificity (Sp), negative predictive value (NPV), positive predictive value (PPV) and likelihood ratio for positive (LR+). Receiver Operator Characteristic Curve (ROC) was used to determine the cut-off point of SNAP and SNAP-PE. Independent-sample T-test is done to determine significance correlation between independent variable and outcome. Result: During 16 months of study, from April 2001 to July 2002, 62 neonates were collected with both SNAP and SNAP-PE score. SNAP score of 15 showed 61% of Se, 94% of Sp, 96% of PPV, 50% of NPV and LR+ was 11. Cut-off point SNAP was 9 showed 84% of sensitivity, 83% of specificity, 93% of PPV, 68% of NPV and LR+ was 5. Analysis SNAP-PE 28 revealed 29.5% of sensitivity, 94.4% of specificity, 92.8% of PPV, 35.4% of NPV and LR+ was 5,26. Cut-off point SNAP-PE was 18 showed 70% of sensitivity, 72% of specificity, 86% of PPV, 50% of NPV and LR + is 2,5. Clinical disagreement SNAP-PE and SNAP showed value of kappa=0,4. Conclusion: SNAP 15 and SNAP-PE is not a valid tool to access neonatal mortality. Keyword: Neonates, SNAP score, predictor of mortality. Lakar belakang: Diperlukan pengelolaan perawatan yang efektif dan efisien pada neonatus sakit kritis yang dirawat di Unit Perawatan Intensif Neonatus (NICU). Untuk itu diperlukan ketajaman diagnostik, pemantauan ketat, maupun tersedianya sarana pendukung yang memadai untuk menekan angka kematian. Score for Neonatal Acute Physiology (SNAP) dan Score for Neonatal Acute Physiology Perinatal Extension (SNAP-PE) merupakan alat untuk menduga kematian neonatus sakit kritis yang dirawat di NICU, disusun berdasarkan aspek fisiologi tubuh dengan menilai tingkat disfungsi fisiologi organ. Tujuan penelitian: menilai akurasi dan derajat kesesuaian Minis SNAP dan SNAP-PE sebagai alat duga kematian neonatus di NICU. Desain penelitian: Uji diagnostik. Subyek penelitian: pasien neonatus sakit kritis dirawat di NICU RS. dr. Kariadi Semarang, memenuhi 'criteria inklusi yaitu lahir di RS dr. Kariadi, umur kurang 7 hari, talc disertai kelainan kongenital berat dan memenuhi skor SNAP / SNAP-PE. Analisis: Uji diagnostik untuk menilai sensitifitas, spesifisitas, nilai duga positif, nilai duga negatif dan rasio kemungkinan positif benar. Uji t-test digunakan untuk menilai kemaknaan variabel berat lahir, masa gestasi dan skor apgar terhadap hasil akhir. Hasil: Selama kurun waktu 16 bulan, mulai april 2001 sampai Juli 2002 diperoleh sejumlah 62 sampel penelitian. Uji diagnostik SNAP 15 untuk menduga kematian neonatus, diperoleh sensitifitas 61%, spesifisitas 94%, nilai duga positif 96%, nilai duga negatif 50% dan rasio kemungkinan positif benar 11. Titik potong terbaik SNAP pada kurva ROC adalah skor 9 dengan sensitifitas 84%, spesifisitas 83%, nilai duga positif 93%, nilai duga negatif 68% dan rasio kemungkinan positif benar 5. Analisis uji diagnostik SNAP-PE 28 didapatkan sensitifitas 29.5%, spesifisitas 94.4%, nilai duga positif 92.8%, nilai duga negatif 35.4% dan rasio kemungkinan positif benar 5,26. Titik potong terbaik SNAP-PE pada kurva ROC adalah 18 dengan nilai sensitifitas 70%, spesifisitas 72%, nilai duga positif 86%, nilai duga negatif 50% dan rasio kemungkinan positif benar adalah 2,5. Derajat kesesuaian Minis antara SNAP-PE dengan SNAP diperoleh nilai kappa 0,4, termasuk kategori kurang baik. Kesimpulan: SNAP 15 merupakan alat ukur duga kematian neonatus yang tidak memenuhi syarat akurat. Skor SNAP-PE merupakan alat ukur duga kematian yang kurang akurat di NICU RS. Dr. Kariadi Semarang. Keandalan SNAP-PE adalah kurang baik. Kata kunci: Neonatus, skor SNAP, alat duga kematian.