Comparative Assessment of the Critical Condition of Newborns with Congenital Anomalies on the Basis of Different Scales.

Abstract

Objective: Various assessment scales have been developed to evaluate the severity of critical conditions in patients admitted to neonatal intensive care units (NICUs), predicting the length of stay, likelihood of complications, and death. Congenital anomalies, though a significant portion of NICU admissions, are often excluded from such studies. The aim of our study was to compare the informativeness of different scoring systems in the assessment of critical patients with congenital anomalies treated in the NICU, as well as their applicability in predicting complications and fatal outcomes. Materials and Methods: Between 2019 and 2022, we evaluated the severity of the critical condition of 921 newborns diagnosed with congenital anomalies at the Scientific Research Pediatric Institute named after K. Farajova using the National therapeutic intervention evaluation system (NTISS), scores for neonatal acute physiology (SNAPPE II), clinical risk index for babies (CRIB), and the mortality index for neonatal transportation score (MINT) scales. Results: Of the 921 neonates with congenital anomalies admitted to the NICU in critical condition, 271 (29.4%) were preterm (≤37 weeks) and 650 (70.6%) were term. In 921 patients diagnosed with congenital anomalies, the mean NTISS score according to the scales was 18.6; SNAPPE II 14.2; CRIB 4.6; MINT 6.9. In these patients, when the mean score of preterm and term births was compared according to gestational week, the SNAPPE II and MINT points were statistically significantly higher in preterm babies than terms. In the comparative analysis between the patients of the surviving and lethal groups, it was found that all the scales (SNAPPE II, NTISS, CRIB, MINT) were statistically significant. Conclusion: National therapeutic intervention evaluation system, SNAPPE II, CRIB, and MINT scales are useful in predicting mortality in newborns with congenital anomalies. However, these scales do not account for the severity of the congenital anomalies, system damage relationships, complication effects, or treatment needs (need for surgical intervention). Tailored scale usage corresponding to medical service levels in different countries would improve affordability and predictability.