WOFAPS 2025 8th World Congress of Pediatric Surgery

Sphamandla Zulu, Andrew Grieve, Karen Milford

Department of Paediatric Surgery, University of the Witwatersrand

Background:
Surgical neonates represent a high-risk population with elevated morbidity and mortality, particularly in settings with limited specialized neonatal infrastructure. The score for neonatal acute physiology with perinatal extension II (SNAPPE II) is a validated neonatal intensive care units (NICU) prognostic tool, though its application in surgical neonates is not well established. This study assessed the clinical profiles, outcomes, and prognostic utility of SNAPPE II in neonates undergoing surgical management at a quaternary paediatric centre in South Africa.

Methods:
A retrospective cohort study was conducted of all neonates admitted under general paediatric surgery to the NICU at Nelson Mandela Children’s Hospital from July 2018 to June 2023. Clinical, demographic, operative, and outcome data were analysed. SNAPPE II scores were calculated within the first 12 hours of admission. Morbidity was graded using the Clavien-Dindo classification. Survival analysis, receiver operating characteristic (ROC) curves, and odds ratios were used to assess prognostic associations.

Results:
Of 422 neonates, 380 were included. Most were premature (68.8%) and low birth weight (62.8%). Overall mortality was 22.6%, with sepsis accounting for 65.1% of deaths. SNAPPE II scores correlated strongly with mortality: 82% of neonates with scores 0–9 survived; all with scores ≥40 died. A threshold effect was noted at scores ≥20. ROC analysis demonstrated excellent discriminative ability, with area under the curve (AUC) of 0.91. A SNAPPE II cut-off of ≥10 yielded a sensitivity of 82.6%, specificity of 82.0%, and NPV of 94.1%. Culture-positive sepsis was associated with a fivefold increased risk of death (OR 4.92; 95% CI: 2.67–9.09). Complex gastroschisis and NEC were the leading fatal diagnoses. Postoperative morbidity occurred in 17.4%, primarily due to surgical site infection.

Conclusion:
SNAPPE II provides reliable risk stratification in surgical neonates and may guide perioperative decision-making, counselling, and resource prioritization in high-acuity neonatal surgical settings.