# Outcomes of general paediatric surgical neonates managed at the Nelson Mandela Children’s Hospital, Johannesburg, South Africa

## TL;DR

This study shows that the SNAPPE II score effectively predicts mortality in surgical neonates in a South African hospital, helping with early triage and resource allocation.

## Contribution

The study validates the use of SNAPPE II for predicting mortality in surgical neonates in sub-Saharan Africa.

## Key findings

- Overall mortality was 22.6%, with sepsis responsible for 65.1% of deaths.
- SNAPPE II scores >20 were associated with significantly increased mortality (relative risk 9.2, odds ratio 43.7).
- No neonates survived with SNAPPE II scores ≥40, and the score showed excellent discrimination (AUC 0.88).

## Abstract

Early identification of high-risk surgical neonates is essential in resource-limited settings. Risk stratification tools such as the Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE II) are widely used in neonatal intensive care units but have not been validated in surgical neonatal populations in sub-Saharan Africa. This study evaluated outcomes and the prognostic utility of SNAPPE II in surgical neonates.

A 5-year retrospective cohort study was conducted including neonates admitted under general paediatric surgery to the neonatal intensive care unit at Nelson Mandela Children’s Hospital. SNAPPE II scores were calculated within 12 h of admission. Associations between SNAPPE II and mortality were assessed using relative risk, odds ratios, and receiver operating characteristic (ROC) analysis.

380 neonates were analysed. Overall mortality was 22.6%, with sepsis accounting for 65.1% deaths. SNAPPE II demonstrated strong prognostic performance: scores > 20 were associated with markedly increased mortality (relative risk 9.2, odds ratio 43.7), and no neonates survived with scores ≥ 40. ROC analysis showed excellent discrimination (AUC 0.88), with an optimal cut-off of 25.

SNAPPE II reliably predicts mortality in surgical neonates and supports early triage, rational resource allocation, and informed family counselling in resource-limited neonatal surgical units.

The online version contains supplementary material available at 10.1007/s00383-026-06365-y.