Neonatal Transport: Application of the SNAPPE II and Hermansen Scores in Newborns

Introduction In neonatal transport, continuous reassessment of medical interventions, anticipation of complications, technical skills, and team adherence are key factors for successful patient stabilization. Several physiological scoring systems have been developed and validated to assess morbidity and mortality risk. Objective: To apply the SNAPPE II and Hermansen scores in transferred neonates and to analyze their final outcome at discharge. Methods: Transfers of newborns over a two-year period were analyzed, including both local and out-of-town referrals. SNAPPE II and Hermansen scores were applied. Results: A total of 214 neonatal transfers were received over 24 months. Of these, 141 (66%) originated outside the municipality and 73 (34%) were local. Sixty-one neonates died (28.5%). The Hermansen score showed a mean of 8 (SD 0.78) among survivors and a mean of 1 (SD 0.00) among non-survivors (p < 0.01). A Hermansen score <8 compared to ≥8 was associated with an odds ratio for mortality of 22.5 (95% CI 2.1–240; Z = 2.57; p = 0.01). Among the remaining 190 neonates weighing ≥1,500 g, SNAPPE II scores showed a mean of 10.24 (SD 13.8) in survivors versus 15.7 (SD 19.9) in non-survivors (p = 0.08). The odds ratio for mortality was 1.90 (95% CI 0.09–3.98; p = 0.08). Conclusion: In this study, SNAPPE II was not predictive of mortality in neonates with scores ≥20. The Hermansen score applied to neonates weighing <1,500 g was significantly associated with increased mortality when scores were <8. The Hermansen physiological index proved to be a strong predictor of mortality. Therefore, very low birth weight neonates with Hermansen scores <8 should not be transferred.