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Modified Snappe-II as a Predictor of Severity of Illness Among Human Milk-Fed and Formula-Fed Low Birth Weight Infants: A Systematic Review with Narrative Synthesis


Authors : Salomi S.; Dr. Komala H. K.

Volume/Issue : Volume 11 - 2026, Issue 6 - June

Google Scholar : https://tinyurl.com/3765yrab

Scribd : https://tinyurl.com/ycx8nb4v

DOI : https://doi.org/10.38124/ijisrt/26jun1766

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Abstract : Background: Low birth weight (LBW) infants are at increased risk of adverse clinical outcomes, including severe morbidity and mortality during the neonatal period. The Modified Score for Neonatal Acute Physiology Perinatal Extension-II (SNAPPEII) is widely used to assess illness severity in neonatal intensive care units; however, evidence regarding its predictive performance, particularly in relation to feeding practices, remains fragmented.  Objective: To systematically review the available evidence on the predictive value of the Modified SNAPPE-II score for assessing severity of illness, morbidity, and mortality among human milk-fed and formula-fed low birth weight infants.  Methods: A systematic review with narrative synthesis was conducted in accordance with the PRISMA 2020 guidelines. Electronic databases including PubMed, Scopus, and the Cochrane Library were searched for studies published between January 2001 and March 2025. Studies evaluating the predictive performance of the Modified SNAPPE-II score in low birth weight infants were eligible for inclusion. Two reviewers independently screened studies, extracted data, and assessed methodological quality. Owing to heterogeneity in study design, populations, and reported outcomes, findings were synthesized narratively. Results: Thirteen studies involving diverse neonatal populations met the eligibility criteria. Across the included studies, higher Modified SNAPPE-II scores consistently demonstrated a strong association with neonatal mortality and greater illness severity. Several studies also reported good discriminatory ability for predicting major neonatal complications, including bronchopulmonary dysplasia, severe intraventricular hemorrhage, and prolonged neonatal intensive care unit stay. Although human milk feeding is recognized for improving neonatal outcomes, none of the included studies directly compared the predictive performance of the Modified SNAPPE-II score between human milk-fed and formula-fed low birth weight infants. Consequently, evidence regarding the influence of feeding modality on illness severity prediction remains limited.  Conclusion: The available evidence indicates that the Modified SNAPPE-II score is a reliable tool for early assessment of illness severity and prediction of mortality among low birth weight infants admitted to neonatal intensive care units. However, there is insufficient evidence to determine whether its predictive performance differs according to feeding modality. Well- designed prospective studies comparing human milk-fed and formula-fed low birth weight infants are needed to address this important knowledge gap and to strengthen the clinical application of the Modified SNAPPE-II score.

Keywords : Modified SNAPPE-II; Low Birth Weight; Neonatal Intensive Care Unit; Illness Severity; Neonatal Mortality; Neonatal Morbidity; Human Milk; Formula Feeding; Systematic Review; Narrative Synthesis.

References :

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Background: Low birth weight (LBW) infants are at increased risk of adverse clinical outcomes, including severe morbidity and mortality during the neonatal period. The Modified Score for Neonatal Acute Physiology Perinatal Extension-II (SNAPPEII) is widely used to assess illness severity in neonatal intensive care units; however, evidence regarding its predictive performance, particularly in relation to feeding practices, remains fragmented.  Objective: To systematically review the available evidence on the predictive value of the Modified SNAPPE-II score for assessing severity of illness, morbidity, and mortality among human milk-fed and formula-fed low birth weight infants.  Methods: A systematic review with narrative synthesis was conducted in accordance with the PRISMA 2020 guidelines. Electronic databases including PubMed, Scopus, and the Cochrane Library were searched for studies published between January 2001 and March 2025. Studies evaluating the predictive performance of the Modified SNAPPE-II score in low birth weight infants were eligible for inclusion. Two reviewers independently screened studies, extracted data, and assessed methodological quality. Owing to heterogeneity in study design, populations, and reported outcomes, findings were synthesized narratively. Results: Thirteen studies involving diverse neonatal populations met the eligibility criteria. Across the included studies, higher Modified SNAPPE-II scores consistently demonstrated a strong association with neonatal mortality and greater illness severity. Several studies also reported good discriminatory ability for predicting major neonatal complications, including bronchopulmonary dysplasia, severe intraventricular hemorrhage, and prolonged neonatal intensive care unit stay. Although human milk feeding is recognized for improving neonatal outcomes, none of the included studies directly compared the predictive performance of the Modified SNAPPE-II score between human milk-fed and formula-fed low birth weight infants. Consequently, evidence regarding the influence of feeding modality on illness severity prediction remains limited.  Conclusion: The available evidence indicates that the Modified SNAPPE-II score is a reliable tool for early assessment of illness severity and prediction of mortality among low birth weight infants admitted to neonatal intensive care units. However, there is insufficient evidence to determine whether its predictive performance differs according to feeding modality. Well- designed prospective studies comparing human milk-fed and formula-fed low birth weight infants are needed to address this important knowledge gap and to strengthen the clinical application of the Modified SNAPPE-II score.

Keywords : Modified SNAPPE-II; Low Birth Weight; Neonatal Intensive Care Unit; Illness Severity; Neonatal Mortality; Neonatal Morbidity; Human Milk; Formula Feeding; Systematic Review; Narrative Synthesis.

Paper Submission Last Date
31 - July - 2026

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