Article Text

  1. E. C. Fiedrich,
  2. S. K. Lee*
  1. The University of British Columbia, BC, Canada
  2. *The University of Alberta, AB, Canada and The Canadian Neonatal Network (CNN)


Preamble The Transport Risk Index of Physiologic Stability (TRIPS) is an additive measure of instantaneous physiologic stability of the infant before and after transport. The Neonatal Therapeutic Intervention Scoring System (NTISS) is an additive measure of treatment intensity. The Score for Neonatal Acute Physiology (SNAP-II) is an additive, physiology-based illness severity score calculated 12 hours following admission.

Purpose To determine how the treatment intensity (NTISS) affects the measurement of the illness severity (SNAP-II) following admission to the neonatal intensity care unit (NICU).

Methods The outcomes of 5,662 transported neonatal admissions from 17 tertiary referral perinatal centers were analyzed from January 1996 to October 1997. Post-transport TRIPS scores, SNAP-II scores, and NTISS scores were calculated. The post-transport TRIPS scores were arbitrarily stratified into five equal groups. For a given post-transport group (TRIPS), the treatment intensity (NTISS) was divided into quartiles. Descriptive statistics were used to determine whether high treatment intensity measured by NTISS reduces the mean SNAP-II illness severity score for a given post-transport TRIPS group.

Results The treatment intensity after NICU admission was found to be correlated with the SNAP-II score (Pearson correlation 0.60). Thus, a high NTISS score is correlated with high SNAP-II score. This result contradicts our initial hypothesis that a higher treatment intensity (NTISS) would reduce the illness severity score (SNAP-II). Of note, the patients within each post-TRIPS group had mean post-TRIPS values that were not statistically different. Hence, the different treatment intensities (NTISS) within a given post-TRIPS category are comparable.

Conclusions The use of SNAP-II to measure illness severity may introduce treatment contamination since it is measured over a 12-hour period. TRIPS may solve the problems of SNAP-II since it is an instantaneous measurement of illness severity. Thus, it is possible that treatment intensity may affect outcomes, that is, providing more treatment may not necessarily result in a more favorable outcome. In order to determine whether high treatment intensity (NTISS) is the cause of high illness severity (SNAP-II), we must determine whether TRIPS can overcome the inadequacies of SNAP-II. Hopefully, with further research, this may be accomplished by validating a TRIPS score at 12 hours post-admission to the NICU.

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