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Ventura MWS, Lima GA, da Silva VM, Lopes MVDO, Lima FET. Concept analysis of Neonatal Near Miss. J Pediatr Nurs 2024; 77:e411-e419. [PMID: 38760301 DOI: 10.1016/j.pedn.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE To analyze the concept of Neonatal Near Miss (NNM) using Walker and Avant's method. METHOD This study employs conceptual analysis following Walker and Avant's model, involving concept selection, objective definition, identification of potential uses, determination of attributes, model case creation, additional case consideration, antecedent identification, consequent analysis, and empirical reference examination. To elucidate the concept, a scoping review was conducted across journals indexed in scientific databases such as Web of Science, EMBASE, SCOPUS, and MEDLINE/PubMed. RESULTS The analysis encompassed 43 articles, revealing diverse definitions of neonatal near miss across different contexts. A comprehensive definition emerged from identified antecedents: risk of death, susceptibility to adverse outcomes, and potential adverse events. These antecedents were categorized into maternal conditions, neonatal conditions, and healthcare assistance. CONCLUSION The analysis and definition of the NNM concept was successful, and its antecedents, attributes, and consequences were delineated. IMPLICATIONS Identifying the risk factors associated with NNM cases may contribute to reducing infant morbidity and mortality and improving the quality of care, facilitating future research and improving the use of the NNM concept.
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Modes PSSDA, Gaíva MAM, Andrade ACDS, Fujimori E. Near miss neonatal in the capital of the Brazilian Midwest: a case-control study. CIENCIA & SAUDE COLETIVA 2024; 29:e17462022. [PMID: 38198331 DOI: 10.1590/1413-81232024291.17462022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/17/2023] [Indexed: 01/12/2024] Open
Abstract
We aimed to analyze factors associated with neonatal near-miss in Cuiabá, State of Mato Grosso, Brazil by performing a case-control study of live births in a capital city of central-western Brazil from January 2015 to December 2018 that included 931 cases and 1,862 controls. Data were obtained from the Live Births Information System and the Mortality Information System and variables were organized according to the hierarchical model. Association was analyzed by logistic regression with a 5% significance level. Data were expressed as crude and adjusted odds ratio (OR) and respective confidence intervals (95%CI). The following factors were associated with neonatal near miss: mothers with two (OR = 1.63; 95%CI: 1.01-2.63) or three or more previous pregnancies (OR=1.87; 95%CI: 1.09-3.21), without any live children (OR = 2.57; 95%CI: 1.56-4.24 ) or one live child at birth (OR = 1.53; 95%CI: 1.04-2.26), multiple pregnancy (OR = 4.57; 95%CI: 2.95-7.07), fewer than six prenatal consultations (OR = 2.20; 95%CI: 1.77-2.72), whose deliveries took place in public/university hospitals (OR = 2.25; 95%CI: 1.60-3.15) or philanthropic hospitals (OR = 1.62; 95%CI: 1.16-2.26), with non-cephalic presentation (OR = 2.71 95%CI: 1.87-3.94) and uninduced labor (OR = 1.47; 95%CI: 1.18-1.84).
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Affiliation(s)
- Priscilla Shirley Siniak Dos Anjos Modes
- Programa de Pós-Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Federal de Mato Grosso. Av. Alexandre Ferronato 1200. Bairro Residencial Cidade Jardim. 78550-728 Sinop MT Brasil.
| | | | | | - Elizabeth Fujimori
- Departamento de Enfermagem em Saúde Coletiva, Escola de Enfermagem, Universidade de São Paulo. São Paulo SP Brasil
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Colomar M, de Mucio B, Sosa C, Gomez R, Mainero L, Souza RT, Costa ML, Luz AG, Sousa MH, Cruz CM, Chevez LM, Lopez R, Carrillo G, Rizo U, Saint Hillaire EE, Arriaga WE, Guadalupe RM, Ochoa C, Gonzalez F, Castro R, Stefan A, Moreno A, Serruya SJ, Cecatti JG. Neonatal outcomes according to different degrees of maternal morbidity: cross-sectional evidence from the Perinatal Information System (SIP) of the CLAP network. Glob Health Action 2023; 16:2269736. [PMID: 37886828 PMCID: PMC10795600 DOI: 10.1080/16549716.2023.2269736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The burden of maternal morbidity in neonatal outcomes can vary with the adequacy of healthcare provision and tool implementation to improve monitoring. Such information is lacking in Latin American countries, where the decrease in severe maternal morbidity and maternal death remains challenging. OBJECTIVES To determine neonatal outcomes according to maternal characteristics, including different degrees of maternal morbidity in Latin American health facilities. METHODS This is a secondary cross-sectional analysis of the Perinatal Information System (SIP) database from eight health facilities in five Latin American and Caribbean countries. Participants were all women delivering from August 2018 to June 2021, excluding cases of abortion, multiple pregnancies and missing information on perinatal outcomes. As primary and secondary outcome measures, neonatal near miss and neonatal death were measured according to maternal/pregnancy characteristics and degrees of maternal morbidity. Estimated adjusted prevalence ratios (PRadj) with their respective 95% CIs were reported. RESULTS In total 85,863 live births were included, with 1,250 neonatal near miss (NNM) cases and 695 identified neonatal deaths. NNM and neonatal mortality ratios were 14.6 and 8.1 per 1,000 live births, respectively. Conditions independently associated with a NNM or neonatal death were the need for neonatal resuscitation (PRadj 16.73, 95% CI [13.29-21.05]), being single (PRadj 1.45, 95% CI [1.32-1.59]), maternal near miss or death (PRadj 1.64, 95% CI [1.14-2.37]), preeclampsia (PRadj 3.02, 95% CI [1.70-5.35]), eclampsia/HELPP (PRadj 1.50, 95% CI [1.16-1.94]), maternal age (years) (PRadj 1.01, 95% CI [<1.01-1.02]), major congenital anomalies (PRadj 3.21, 95% CI [1.43-7.23]), diabetes (PRadj 1.49, 95% CI [1.11-1.98]) and cardiac disease (PRadj 1.65, 95% CI [1.14-2.37]). CONCLUSION Maternal morbidity leads to worse neonatal outcomes, especially in women suffering maternal near miss or death. Based on SIP/PAHO database all these indicators may be helpful for routine situation monitoring in Latin America with the purpose of policy changes and improvement of maternal and neonatal health.
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Affiliation(s)
- Mercedes Colomar
- Department of Research, Latin American Center for Perinatology (CLP-PAHO), Montevideo, Uruguay
| | - Bremen de Mucio
- Department of Research, Latin American Center for Perinatology (CLP-PAHO), Montevideo, Uruguay
| | - Claudio Sosa
- Department of Research, Latin American Center for Perinatology (CLP-PAHO), Montevideo, Uruguay
| | - Rodolfo Gomez
- Department of Research, Latin American Center for Perinatology (CLP-PAHO), Montevideo, Uruguay
| | - Luis Mainero
- Department of Research, Latin American Center for Perinatology (CLP-PAHO), Montevideo, Uruguay
| | - Renato T. Souza
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Maria L. Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Adriana G. Luz
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Maria H. Sousa
- Department of Statistics, Jundiaí School of Medicine - HU/FMJ, Jundiaí, Brazil
| | - Carmen M. Cruz
- Department of Obstetrics, Hospital Berta Calderon Roque, Managua, Nicaragua
| | - Luz M. Chevez
- Department of Obstetrics, Hospital Berta Calderon Roque, Managua, Nicaragua
| | - Rita Lopez
- Department of Obstetrics, Hospital Berta Calderon Roque, Managua, Nicaragua
| | - Gema Carrillo
- Department of Obstetrics, Hospital España, Chinandega, Nicaragua
| | - Ulises Rizo
- Department of Obstetrics, Hospital España, Chinandega, Nicaragua
| | - Erika E. Saint Hillaire
- Department of Obstetrics, Hospital San Lorenzo de Los Mina, Santo Domingo, Dominican Republic
| | - William E. Arriaga
- Department of Obstetrics, Hospital Regional de Ocidente, Quetzaltenango, Guatemala
| | - Rosa M. Guadalupe
- Department of Obstetrics, Hospital Regional de Ocidente, Quetzaltenango, Guatemala
| | | | - Freddy Gonzalez
- Department of Obstetrics, Hospital Roberto Suazo Cordova, La Paz, Honduras
| | - Rigoberto Castro
- Department of Obstetrics, Hospital Roberto Suazo Cordova, La Paz, Honduras
| | - Allan Stefan
- Department of Obstetrics, Hospital Leonardo Martinez Valenzuela, San Pedro Sula, Honduras
| | - Amanda Moreno
- Department of Obstetrics, Hospital Boliviano Japones, La Paz, Bolivia
| | - Suzanne J. Serruya
- Department of Research, Latin American Center for Perinatology (CLP-PAHO), Montevideo, Uruguay
| | - José G. Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
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Chafik K, Aslaou F, Barich F, Laamiri FZ, Barkat A. Factors associated with neonatal near miss: Case of the University Hospital Center IbnSina of Rabat Morocco 2021. J Neonatal Perinatal Med 2023; 16:105-110. [PMID: 36872798 DOI: 10.3233/npm-221167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
OBJECTIVES Analogous to the Near Miss Maternal approach, the concept of Near Miss Neonatal (NNM) is an approach recently developed to identify newborns who survive near-fatal complications during the first 28 days of ectopic life. The objective of this study is to shed light on the cases of Neonatal Near Miss and identify its factors associated with live births. METHODS A prospective cross-sectional study was conducted to identify factors associated with Neonatal Near Miss in newborns admitted to the National Reference Center in Neonatology in Rabat, Morocco from January 1 to December 31, 2021. A pre-tested, structured questionnaire was used to collect the data. These data were entered using Epi Data software and exported to SPPS23 for analysis. To identify the determinants of the outcome variable, binary multivariable logistic regression was used. RESULTS Among the 2676 selected live births, 2367 (88.5% ; 95% CI: 88.3-90.7)) were cases of NNM. Factors in women which were significant predictors of NNM included being referred from other health care facilities [AOR: 1.86; 95% CI: 1.39-2.50], residing in a rural area [AOR: 2.37; 95% CI: 1.82-3.10], having less than four prenatal visits [AOR: 3.17; 95% CI: 2.06-4.86], and having gestational hypertension [AOR: 2.02; 95% CI: 1.24-3.30]. CONCLUSIONS This study revealed a high proportion of NNM cases in the study area. The factors associated with NNM which were found to increase these cases demonstrates the primary health care program must be further improved to avoid preventable causes of neonatal mortality.
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Affiliation(s)
- K Chafik
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.,Higher Institute of Nursing Professions and Health Techniques, Rabat, Morocco
| | - F Aslaou
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.,Higher Institute of Nursing Professions and Health Techniques, Rabat, Morocco
| | - F Barich
- Higher Institute of Nursing Professions and Health Techniques, Rabat, Morocco
| | - F Z Laamiri
- Hassan First University of Settat, Higher Institute of Health Sciences, Settat, Morocco
| | - A Barkat
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Chafik K, Aslaou F, Barich F, Laamiri FZ, El Ouardighi I, Barkat A. The Prevalence of Neonatal Near Misses in Rabat, Morocco. Cureus 2023; 15:e34486. [PMID: 36874298 PMCID: PMC9982691 DOI: 10.7759/cureus.34486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The concept of near-miss neonatal (NMN) is a potentially useful approach in assessing the quality of newborn care. However, data collected on the status of NMN cases in Morocco is scarce. OBJECTIVE The objective of this study is to determine the prevalence of NMN cases among live births at the University Hospital of Rabat, Morocco. MATERIALS AND METHODS An observational cross-sectional study was conducted on 2676 newborns born at the University Hospital of Rabat, Morocco, and admitted to the National Reference Center of Neonatology and Nutrition (NRCN) from January 1 to December 31, 2021. The main inclusion criteria were the pragmatic and/or management markers of the definition of NMN. Data were extracted using a structured, pre-tested checklist, entered into EpiData, and exported to Statistical Software for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY), and descriptive statistics were performed. RESULTS Among the 2676 selected live births, 2367 were NMN cases (88.5%; 95% CI: 88.3-90.7). More than half of new mothers (57.5%) were referrals, 59.9% of women were multiparous, and 78.5% had under four prenatal care consultations. Obstetric problems affected 373 of the women during pregnancy. A pragmatic criterion was met in 43.6% of NMN situations. Among the management criteria, the use of intravenous antibiotics was the most common factor at 56.0%. CONCLUSIONS This study revealed a high prevalence of NMN. Therefore, concerted efforts are needed to improve maternal health care services, including early identification of complications and appropriate management.
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Affiliation(s)
- Kawtar Chafik
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Fatima Aslaou
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Fatima Barich
- Research, Higher Institute of Nursing Professions and Health Techniques, Rabat, MAR
| | - Fatim Zahra Laamiri
- Laboratory of Health Sciences and Technology, Hassan First University of Settat, Higher Institute of Health Sciences of Settat, Settat, MAR
| | - Ilham El Ouardighi
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Amina Barkat
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
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Rocha NM, Kale PL, Fonseca SC, Brito ADS. Neonatal near miss and mortality and associated factors: cohort study of births in the city of Rio de Janeiro, RJ, Brazil. REVISTA PAULISTA DE PEDIATRIA 2023; 41:e2021302. [DOI: 10.1590/1984-0462/2023/41/2021302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022]
Abstract
Abstract Objective: The aim of this study was to investigate factors associated with neonatal near miss and mortality of the live birth cohort in the city of Rio de Janeiro, Brazil, in 2015. Methods: Population-based retrospective cohort of live births (LB) of single pregnancy with 0–27 days of follow-up. Data were obtained from the Brazilian Live Birth and Mortality Information Systems. Logistic regressions with the analytical strategy of hierarchical determination were used for cases of near miss and deaths separately. Results: The cohort was composed of 85,850 LB. For every one thousand LB, about 16 were cases of near miss and six died. Maternal level of education, skin color, and age and adequacy of prenatal care were associated with neonatal near miss; for deaths, presentation of LB at delivery, birth weight, gestational age, and five-minute Apgar score are added. Conclusions: Besides confirming the effect of low birth weight, prematurity, and asphyxia on neonatal death, socioeconomic vulnerability markers – low education level and brown or black skin colors – were associated with neonatal death and near miss. Absent or inadequate prenatal care showed a strong association with both outcomes, being stronger for neonatal death. Investments in the quality of prenatal care and reduction of disparities in health care are necessary in Rio de Janeiro.
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Melkamu Asaye M, Gelaye KA, Matebe YH, Lindgren H, Erlandsson K. Valid and reliable neonatal near-miss assessment scale in Ethiopia: a psychometric validation. Glob Health Action 2022; 15:2029334. [PMID: 35107412 PMCID: PMC8812796 DOI: 10.1080/16549716.2022.2029334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The concept of a neonatal near miss is used to explain neonates who nearly died but survived a life-threatening complication in the first 28 days of life. We have left many ill surviving (near-miss) neonates, due to a lack of valid and reliable assessment scale, particularly in Ethiopia. Aim We aim to psychometrically validate the neonatal near-miss assessment scale (NNMAS) for Ethiopia. Methods A total of 465 live birth neonates were included with the assumption of a participant-to-item ratio of 15:1. A new contextually validated NNMAS was used to collect data. The Kaiseri––Mayer––Olkin (KMO) measure of sampling adequacy with a cutoff value of ≥0.50 for each item was applied. For reliability and validity of NNMAS, exploratory factor analysis using principal component analysis with oblique varimax rotation was used. Internal consistency and reliability were assessed using Cronbach’s alpha. Convergent and discriminant validity was assessed using composite reliability (CR) and average variance extracted (AVE). Results The Kaiser––Mayer––Olkin (KMO = 0.74) measure of sampling adequacy and Bartlett’s Sphericity test for the appropriateness of the identity matrix (χ2 = 2903.9, df = 276, and P = 0.000) were suitable for exploratory factor analysis (EFA). The correlation matrix determinant of the study was 0.002. The principal component analysis (PCA) identified six factors and together explained 54.3% of the variation in the Neonatal Near miss. The Cronbach-alpha coefficient was 0.80 for the entire scale. The composite reliability values of the factors ranged from 0.87 to 0.95. The AVEs, CR, and factor loadings were above 0.5 for all factors indicating that convergent validity was met. The square roots of the AVEs were greater than factor correlation values. It was revealed that discriminated validity was also met. Conclusion The neonatal near-miss assessment scale was found to be valid and reliable in the present context. The scale can be used to identify near-miss neonates in Ethiopia.
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Affiliation(s)
- Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Hailu Matebe
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden.,Institution for Health and Welfare, Dalarna University, Falun, Sweden
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Debele GR, Siraj SZ, Tsegaye D, Temesgen E. Determinants of neonatal near-miss among neonates delivered in public hospitals of Ilu Abba Bor Zone, Southwest Ethiopia: An unmatched case-control study during the COVID-19 pandemic. Front Public Health 2022; 10:923408. [PMID: 36203670 PMCID: PMC9531017 DOI: 10.3389/fpubh.2022.923408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/23/2022] [Indexed: 01/22/2023] Open
Abstract
Background The neonatal period is the time with the highest risk of neonatal and infant mortality. The COVID-19 pandemic diverted resources from routine maternal health services, which raises the possibility of neonatal near misses (NNMs). To implement prompt treatments that could improve the standard of infant care and lower neonatal mortality, it has been theorized that pinpointing the determinants of NNM during this outbreak is crucial. In light of this, the current study identified the determinants of NNM in neonates delivered in public hospitals of Ilu Abba Bor Zone, South West Ethiopia. Methods An institution-based unmatched case-control study was conducted among randomly selected 303 (101 cases and 202 controls) neonates admitted to Mettu Karl Comprehensive Specialized Hospital (MKCSH) and Darimu Primary Hospital (DPH) from 1 November to 28 December 2020. Data were collected using interviewer-administered structured questionnaire and checklist. The collected data were coded and entered into Epi-Data version 4.6 and then exported to SPSS version 20 for analysis. Adjusted odds ratios (AOR) along with a 95% confidence interval was used to assess the strength of the association, and a p-value < 0.05 was considered to declare the statistical significance in the multivariable logistic regression analysis. Result A total of 303 (101 cases and 202 controls) neonates admitted to MKCSH and DPH were included in the study making a 97.4% response rate. In the multivariable logistic regression analysis, no formal maternal education [AOR = 3.534, 95% CI: (1.194-10.455)], Breech presentation during birth [AOR = 3.088, 95% CI: (1.029-9.268)], < 4 antenatal care (ANC) visits [AOR = 1.920, 95% CI: (1.065-3.461], cesarean section delivery [AOR = 4.347, 95% CI: (1.718-10.996)], antepartum hemorrhage (APH) [AOR = 3.37, 95% CI: (1.23-9.24)], and hypertensive disorders of pregnancy (HDP) [AOR = 4.05, 95% CI: (2.36-11.05)] were independent determinants of NNM. Conclusion The study's result revealed that factors such as education level, birth presentation, ANC visit, mode of delivery, APH, and HDP continued to be important determinants of the NNM in Ethiopia during this pandemic. Therefore, much work is needed to improve neonatal health by providing adequate ANC services and other identified potential determinant factors that predispose the newborn to life-threatening (near-miss) conditions especially during this pandemic.
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Affiliation(s)
- Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Sabit Zenu Siraj
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Dereje Tsegaye
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Ermiyas Temesgen
- Department of Public Health, Mettu Health Science College, Mettu, Ethiopia
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Gutema EA, Getachew Erena M, Kasaye HK. Neonatal near miss and associated factors among neonates admitted to neonatal intensive care unit of hospitals in East Wollega, Western Ethiopia, 2019. SAGE Open Med 2022; 10:20503121221107463. [PMID: 35898954 PMCID: PMC9310276 DOI: 10.1177/20503121221107463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Neonatal near miss is an infant who nearly died but survived from birth to 28 days. Neonatal period is the most vulnerable time for child’s healthiness and continued existence. Globally, about 2.5 million children died in their first month of life and 7000 die/day. Objective: To assess neonatal near miss and associated factors among neonates admitted to intensive care unit at hospitals in East Wollega, West Ethiopia, 2019. Methods: Quantitative, facility-based cross-sectional study was conducted from 15 July to 30 August 2019 on 403 neonates admitted to neonatal intensive care unit of hospitals. After ethical clearance, five recruited and trained nurses collected the data with pretested structured questionnaire. Neonates sampled were selected using systematic random sampling. Data entered into Epi-info version 7.1 and exported to SPSS Version 24. Binary logistic regression was performed, and adjusted odds ratio with P-value ⩽ 0.05 at 95% confidence interval was used as statistically significant. Results: All, 403, study participants were included in this study, yielding 100% response rate. From these, 196 (48.60%) neonates were near miss. In multivariable logistic regression, mother who lived in rural area (adjusted odds ratio = 3.84, 95% confidence interval = (1.78, 8.31)), cesarean section (adjusted odds ratio = 10.68, 95% confidence interval = (2.95, 38.71)), and neonates referred to hospitals (adjusted odds ratio = 3.32, 95% confidence interval = (3.27, 12.01)). Also, female neonates (adjusted odds ratio = 2.99, 95% confidence interval = (1.45, 6.14)) and multiple birth (adjusted odds ratio = 3.07, 95% confidence interval = (1.32, 7.16)) were significantly associated with neonatal near miss. Conclusion: Neonatal near miss found to be high compared to previously existing research in Brazil. Health institutions, health professionals, and concerned bodies on plan and implementation of neonatal care need to consider these factors during pregnancy, delivery, and for neonates immediate after birth and in neonatal intensive care unit.
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Affiliation(s)
| | - Motuma Getachew Erena
- Department of Public Health, Wollega University, Institute of Health Science, Nekemte, Ethiopia
| | - Habtamu Kebebe Kasaye
- Department of Midwifery, Wollega University, Institute of Health Science, Nekemte, Ethiopia
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Rocha PRH, Bettiol H, Confortin SC, Bazo G, Aristizábal LYG, Simões VMF, Matijasevich A, Santos IS, Silveira MFD, Cavalli RDC, Silva AAMD, Barbieri MA. Factors associated with neonatal-near miss: birth cohorts in three Brazilian cities - Ribeirão Preto, Pelotas and São Luís, Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:2729-2740. [PMID: 35730842 DOI: 10.1590/1413-81232022277.20932021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to investigate the association of sociodemographic factors, lifestyle, maternal reproductive profile and prenatal and childbirth care with neonatal near miss (NNM) morbidity in four birth cohorts. This study involved four population-based birth cohorts: Ribeirão Preto (RP) and São Luís (SL) (2010), Pelotas 2004 (PEL04) and 2015 (PEL15). NNM was defined when one or more of the following conditions were present: birthweight <1,500 g, 5-minute Apgar score <7, gestational age <32 weeks, and report of congenital malformations. The covariates were obtained with questionnaires applied to the puerperal women. Some particularities between cohorts were identified. In the RP and SL cohorts, factors of the more distal levels (sociodemographic, lifestyle, and reproductive profile) were associated with NNM. On the other hand, proximal factors related to healthcare were more significant for the occurrence of NNM in PEL. Only the absence of prenatal care was associated with NNM in all cohorts: RP (OR=4.27, 95%CI 2.16-8.45), SL (OR=2.32, 95%CI 1.09-4.94), PEL04 (OR=4.79, 95%CI 1.59-14.46), and PEL15 (OR=5.10, 95%CI 2.60-9.97).
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Affiliation(s)
- Paulo Ricardo Higassiaraguti Rocha
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP). Av. Bandeirantes 3900, Campus da USP. 14049-900 Ribeirão Preto SP Brasil.
| | - Heloisa Bettiol
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP). Av. Bandeirantes 3900, Campus da USP. 14049-900 Ribeirão Preto SP Brasil.
| | - Susana Cararo Confortin
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão. São Luís MA Brasil
| | - Gabriel Bazo
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP). Av. Bandeirantes 3900, Campus da USP. 14049-900 Ribeirão Preto SP Brasil.
| | | | | | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina, USP. São Paulo SP Brasil
| | - Iná S Santos
- Faculdade de Medicina, Universidade Federal de Pelotas. Pelotas RS Brasil
| | | | - Ricardo de Carvalho Cavalli
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP). Av. Bandeirantes 3900, Campus da USP. 14049-900 Ribeirão Preto SP Brasil.
| | | | - Marco Antonio Barbieri
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP). Av. Bandeirantes 3900, Campus da USP. 14049-900 Ribeirão Preto SP Brasil.
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Assis TDSC, Martinelli KG, Gama SGND, Santos Neto ETD. Associated factors of neonatal near miss among newborns of adolescent mothers in Brazil. Rev Esc Enferm USP 2022; 56:e20210359. [PMID: 35652629 PMCID: PMC10081653 DOI: 10.1590/1980-220x-reeusp-2021-0359en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/01/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the associated factors of neonatal near miss among newborns of Brazilian adolescents and to compare their occurrence in young women aged 12 to 16 years and 17 to 19 years. METHOD Cross-sectional, hospital-based study, using data from the study Nascer no Brasil ("Birth in Brazil") on puerperal adolescents and their newborns in all regions of Brazil. Multiple and univariate logistic regression were employed to identify the associated factors of neonatal near miss. RESULTS The following factors were found to be associated to neonatal near miss among newborns of adolescent mothers: public source of payment (OR = 4.57, 95% CI = 2.02-10.32), having to seek help in different maternity hospitals (OR = 1.52; 95% CI = 1.05-2.20), and maternal near miss (OR = 5.92; 95% CI = 1.94-18.05), in addition to a record of low weight in a previous pregnancy (OR = 3.12; 95% CI = 1.61-6.04) and twin pregnancy (OR = 7.49; 95% CI = 3.28-16.82). CONCLUSION Neonatal near miss affected newborns of adolescent mothers in both age groups equally. Also, the determinant factors of neonatal near miss can be mostly reduced with qualified prenatal, labor, and birth care.
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Affiliation(s)
- Thamara de Souza Campos Assis
- Universidade Federal do Espírito Santo, Departamento de Medicina Social, Programa de Pós-graduação em Saúde Coletiva, Vitória, ES, Brazil
| | - Katrini Guidolini Martinelli
- Universidade Federal do Espírito Santo, Departamento de Medicina Social, Programa de Pós-graduação em Saúde Coletiva, Vitória, ES, Brazil
| | | | - Edson Theodoro Dos Santos Neto
- Universidade Federal do Espírito Santo, Departamento de Medicina Social, Programa de Pós-graduação em Saúde Coletiva, Vitória, ES, Brazil
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Habte A, Lukas K, Melis T, Tamene A, Sahle T, Hailu M, Gizachew A. Determinants of neonatal near miss among neonates admitted to public hospitals in Southern Ethiopia, 2021: A case-control study. PLoS One 2022; 17:e0268041. [PMID: 35522663 PMCID: PMC9075625 DOI: 10.1371/journal.pone.0268041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/15/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Neonatal near-miss (NNM) cases refer to situations in which babies are on the verge of dying between the ages of 0 and 28 days due to severe morbidity that occurs during pregnancy, delivery, or extra-uterine life, but survive either by luck or due to high-quality health care. Identifying NNM cases and addressing their determinants is crucial for devising comprehensive and relevant interventions to tackle neonatal morbidity and mortality. Hence, this study aimed at finding out the determinants of NNM in neonates admitted to public hospitals in Hadiya zone, southern Ethiopia. METHODS A hospital-based unmatched case-control study was conducted in three selected hospitals in southern Ethiopia from May 1 to June 30, 2021. A total of 484 participants took part in the study (121 cases and 363 controls). Controls were chosen using systematic sampling approaches, whereas cases were recruited consecutively at the time of discharge. Cases were selected based on the Latin American Centre for Perinatology (CLAP) criteria of an NNM. A structured interviewer-administered questionnaire and a data extraction checklist were used for data collection. The Data were entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. A multivariable logistic regression analysis with a p-value of <0.05 was used to determine the determinants of NNM. RESULTS Ninety-seven (80.1%) and 56 (46.2%) near-miss cases encountered at least one pragmatic and management criteria, respectively. The most common pragmatic and management criteria were gestational age less than 33 weeks (44.6%) and intravenous antibiotic usage up to 7 days and before 28 days of life (27.3%), respectively. A short birth interval [AOR = 2.15, 95% CI: 1.29, 3.57], lack of ANC [AOR = 3.37; 95%CI: 1.35, 6.39], Caesarean mode of delivery [AOR = 2.24; 95%CI: 1.20, 4.16], the occurrence of a third maternal delay [AOR = 3.47; 95% CI: 2.11, 5.75], and poor birth preparedness and complication readiness (BPCR) plan[AOR = 2.50; 95% CI: 1.49,4.13] were identified as a significant determinants of NNM. CONCLUSION AND RECOMMENDATION The provision of adequate ANC should be a priority for health care providers at service delivery points. To avoid serious neonatal problems, mothers who deliver by Cesarean section should receive more attention from their families and health care providers. Health care providers in the ANC unit should encourage pregnant women to implement the WHO-recommended elements of the BPCR plan. To achieve optimal birth spacing, healthcare providers should focus on the contraceptive provision. Unnecessary delays in health facilities during childbirth should be avoided at all costs.
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Affiliation(s)
- Aklilu Habte
- School of public health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Kaleegziabher Lukas
- School of public health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Tamirat Melis
- Department of public health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Aiggan Tamene
- School of public health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Tadesse Sahle
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Mulugeta Hailu
- School of public health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Addisalem Gizachew
- School of public health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
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Medeiros PDB, Bailey C, Andrews C, Liley H, Gordon A, Flenady V. Neonatal near miss: A review of current definitions and the need for standardisation. Aust N Z J Obstet Gynaecol 2022; 62:358-363. [PMID: 35243623 PMCID: PMC9546208 DOI: 10.1111/ajo.13493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neonatal near miss (NNM) refers to a newborn who almost died in the neonatal period and is often perceived as part of a spectrum that includes stillbirth and neonatal death. NNM audits might improve recognition of risk factors and substandard care, facilitate benchmarking and inform prevention strategies to improve perinatal outcomes. This review shows that available NNM definitions are inconsistent and vary widely. This is likely to undermine the development of effective prevention strategies and global comparisons. Expert opinion may help reaching a consensus, thus enabling targeting of the appropriate population which would lead to more meaningful data for perinatal audits.
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Affiliation(s)
- Poliana de Barros Medeiros
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Cheryl Bailey
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Christine Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Helen Liley
- Mater Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Mater Mothers' Hospital, Brisbane, Queensland, Australia
| | - Adrienne Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
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Assis TDSC, Martinelli KG, Gama SGND, Santos Neto ETD. Fatores associados ao near miss neonatal em recém-nascidos de adolescentes brasileiras. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0359pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Identificar os fatores associados ao near miss neonatal em recém-nascidos de adolescentes brasileiras e comparar sua ocorrência entre as jovens de 12 a 16 anos e as de 17 a 19 anos. Método: Estudo transversal, de base hospitalar, com dados da pesquisa “Nascer no Brasil”, composto por puérperas adolescentes e seus recém-nascidos em todas as regiões do país. Utilizou-se regressão logística univariada e múltipla para identificar os fatores associados ao near miss neonatal. Resultados: Mostraram-se associados ao near miss neonatal de recém-nascidos de mães adolescentes os fatores fonte de pagamento público (OR = 4,57, IC95% = 2,02–10,32), peregrinação por maternidades (OR = 1,52; IC95% = 1,05–2,20) e presença de near miss materno (OR = 5,92; IC95% = 1,94–18,05), além de histórico de baixo peso em gestação anterior (OR = 3,12; IC95% = 1,61–6,04) e gemelaridade (OR = 7,49; IC95% = 3,28–16,82). Conclusão: O near miss neonatal acometeu igualmente os recém-nascidos de mães adolescentes de ambas as faixas etárias. Além disso, os determinantes do near miss neonatal, em sua maioria, podem ser reduzidos com atenção qualificada ao pré-natal, parto e nascimento.
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Analysis of Maternal Factors Impacting Neonatal Near Miss (NNM) Events: A Tertiary Centre Experience. J Obstet Gynaecol India 2021; 72:75-82. [PMID: 35928059 PMCID: PMC9343503 DOI: 10.1007/s13224-021-01554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
Objective To find out the incidence of neonatal near miss (NNM) cases in comparison with the neonatal deaths and to study the different antenatal and intrapartum maternal variables and system-related delays influencing these events. Methodology This is a descriptive retrospective study conducted over a year (2018-2019) at a tertiary referral hospital in India, where NNM cases were selected as per 'pragmatic criteria', and detailed maternal and neonatal biological variables and near miss indicators were procured from the medical record books and analysed. Results Out of 6383 live births and 231 neonatal deaths in the hospital during the study period, 810 NNM cases were identified born to 710 mothers, i.e. 3.5 cases for each neonatal death. Birth weight and gestational age in combination contributed to the maximum number of cases-383 (47.28%). The most common reason for referral was threatened pre-term/PPROM with non-availability of NICU-197 cases (38.3%) out of 514 referrals. Out of 710 mothers, 529 (74.5%) had at least one comorbidity at the time of presentation. The most common comorbidity was anaemia in 267 women followed by hypertensive disorder of pregnancy-in 251 cases. Primary delay contributed to 54% of all delays in the study. Conclusion NNM can be used as an effective tool for quality control and audits to effectively reduce maternal and neonatal morbidity and mortality but needs more research to establish a standardized definition and criteria for selection of cases.
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Sushma R, Norhayati MN, Nik Hazlina NH. Prevalence of neonatal near miss and associated factors in Nepal: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:422. [PMID: 34107909 PMCID: PMC8190855 DOI: 10.1186/s12884-021-03894-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The rate of neonatal mortality has declined but lesser than the infant mortality rate and remains a major public health challenge in low- and middle-income countries. There is an urgent need to focus on newborn care, especially during the first 24 h after birth and the early neonatal period. Neonatal near miss (NNM) is an emerging concept similar to that of maternal near miss. NNM events occur three to eight times more often than neonatal deaths. The objective of this study was to establish the prevalence of NNM and identify its associated factors. METHODS A hospital-based cross-sectional study was conducted in Koshi Hospital, Morang district, Nepal. Neonates and their mothers of unspecified maternal age and gestational age were enrolled. Key inclusion criteria were pragmatic and management markers of NNM and admission of newborn infants to the neonatal intensive care unit (NICU) in Koshi Hospital. Non-Nepali citizens were excluded. Consecutive sampling was used until the required sample size of 1,000 newborn infants was reached. Simple and multiple logistic regression was performed using SPSS® version 24.0. RESULTS One thousand respondents were recruited. The prevalence of NNM was 79 per 1,000 live births. Severe maternal morbidity (adjusted odds ratio (aOR) 4.52; 95% confidence interval (CI) 2.07-9.84) and no formal education (aOR 2.16; 95% CI 1.12-4.14) had a positive association with NNM, while multiparity (aOR 0.52; 95% CI 0.32-0.86) and caesarean section (aOR 0.44; 95% CI 0.19-0.99) had negative associations with NNM. CONCLUSIONS Maternal characteristics and complications were associated with NNM. Healthcare providers should be aware of the impact of obstetric factors on newborn health and provide earlier interventions to pregnant women, thus increasing survival chances of newborns.
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Affiliation(s)
- Rajbanshi Sushma
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
| | - Nik Hussain Nik Hazlina
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
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França KEXD, Vilela MBR, Frias PGD, Chaves MA, Sarinho SW. [Neonatal near miss in referral hospitals for high-risk pregnancy and childbirth: a cross-sectional study]. CAD SAUDE PUBLICA 2021; 37:e00196220. [PMID: 34105622 DOI: 10.1590/0102-311x00196220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022] Open
Abstract
The article aimed to describe and compare indicators of neonatal near miss in referral hospitals for high-risk pregnancy and childbirth. This exploratory study was performed in two general hospitals in Recife, Pernambuco, Brazil. The study included cases of neonatal near miss in the year 2016 with gestational age < 33 weeks, birthweight < 1,750g, 5-minute Apgar < 7, or admission to the neonatal intensive care unit (ICU) and that remained alive at 7 days of life. Data were extracted from the Brazilian Information System on Live Births, Mortality Information System, Hospital Information System, and National Registry of Healthcare Establishments to characterize all live births at the institutions, cases of near miss, and availability of technology. Neonatal near miss and early neonatal mortality rates were calculated. The Pernambuco Maternal-Child Institute (IMIP) received the most serious cases and had the highest neonatal near miss rate (119.21 per thousand live births; p = 0.009) and early neonatal mortality rate (35.22 per thousand live births; p < 0.001). The University Hospital had the highest proportion of neonatal ICU admissions (76% of the near miss cases; p < 0.001). Neonatal near miss rates differed between the hospitals and are useful for surveillance of neonatal care in healthcare institutions, but they require attention to the local profile and context when the objective is to perform evaluations with classification. The findings reflect the complexity of assessing different health services.
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Melkamu Asaye M, Gelaye KA, Matebe YH, Lindgren H, Erlandsson K. Assessment of content validity for a Neonatal Near miss Scale in the context of Ethiopia. Glob Health Action 2021; 14:1983121. [PMID: 34694977 PMCID: PMC8547862 DOI: 10.1080/16549716.2021.1983121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The concept of neonatal near miss is used to identify neonates who nearly died but survived a life-threatening complication in the first 28 days of life. Neonatal mortality is the tip of the iceberg. Quality improvement through utilization of a validated scale and reduction in adverse neonatal outcome is a priority for achieving sustainable development goals. Objectives To develop and assess the content validity of neonatal near-miss scale in the public health hospitals in Amhara Regional State, northwest Ethiopia. Methods A literature review was performed prior to the development of the neonatal near-miss assessment scale. An expert panel committee was formed by health facility practitioners and by the members of the academia. Two rounds of meetings were conducted with the expert panel to reach consensus on the face and content validity. The content validity index, Kappa statistics, and the content validity ratio were computed to estimate the content validity scale of neonatal near miss. Results In this study, four domains (pragmatic, clinical, management, and lab-investigations) with 32 items were identified. The item-level content validity index ranged from 0.7 to 1. The overall scale content validity (S-CVI) (average) for the domains (pragmatic, clinical, management, and lab-investigations) were 0.98, 0.95, 0.96, and 0.96, respectively. The overall S-CVI (universal) was 0.78 to 1, whereas the overall S-CVI (average) of neonatal near miss assessment scale was found to be 0.96. The content validity ratio and Kappa statistics values ranged from 0.6 to 1 and 0.9 to 1 for the respective domains. Conclusion The identified four domains and the respective items were valid enough (content-wise) to be used as identification criteria for neonatal near-miss cases. The scale will contribute to neonatal near-miss identification and also improve the quality of neonatal management care.
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Affiliation(s)
- Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Hailu Matebe
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, KarolinskaInstitute, Solna, Sweden
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, KarolinskaInstitute and Institution for Health and Welfare, Dalarna University, Solna, Sweden
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Pereira TG, Rocha DMD, Fonseca VM, Moreira MEL, Gama SGND. Factors associated with neonatal near miss in Brazil. Rev Saude Publica 2020; 54:123. [PMID: 33295591 PMCID: PMC7688256 DOI: 10.11606/s1518-8787.2020054002382] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/29/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE: This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil. METHODS: This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels. RESULTS: At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk – RR = 1.32; 95%CI 1.04–1.66), cesarean delivery (RR = 1.34; 95%CI 1.07–1.67), smoking (RR = 1.48; 95%CI 1.04–2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98–3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36–5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90–4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36–2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40–2.55) were associated with neonatal near miss. CONCLUSIONS: The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.
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Affiliation(s)
| | - Daniele Marano da Rocha
- Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil
| | - Vânia Matos Fonseca
- Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil
| | - Maria Elisabeth Lopes Moreira
- Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil
| | - Silvana Granado Nogueira da Gama
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Departamento de Epidemiologia em Métodos Quantitativos em Saúde. Rio de janeiro, RJ, Brasil
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Neonatal near Miss and Its Predictors among Neonates Delivered at Debretabor General Hospital, Northern Ethiopia; A Retrospective Analysis. Int J Pediatr 2020; 2020:1092479. [PMID: 33014076 PMCID: PMC7519192 DOI: 10.1155/2020/1092479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/12/2020] [Accepted: 08/28/2020] [Indexed: 11/18/2022] Open
Abstract
Background In many low-resource countries, the progress of neonatal mortality reduction is very slow. The scenario is notably true in sub-Saharan Africa including Ethiopia. For every neonatal death, there are lots of near missed neonates. Generating evidences on the extent and predictors of neonatal near miss is a key step in neonatal mortality reduction efforts. However, there is limited evidence in this aspect in Ethiopia. Objective This study is aimed at assessing the proportion of neonatal near miss and associated factors among neonates delivered at Debretabor General Hospital, Northern Ethiopia, 2019. Methods An institution-based cross-sectional study was conducted on 422 neonates delivered at Debretabor General Hospital from July 1st, 2018, to June 30th, 2019. Both pragmatic and management criteria of definition of neonatal near miss were utilized. A systematic random sampling technique was used to select the cards of the study participants. Data were extracted with structured and pretested checklist, entered in the EpiData, and then exported to SPSS version 20. Both descriptive and analytical procedures have been done. Descriptive statistics such as frequencies and cross tabulations were carried out. The binary logistic regression model was fitted and variables with p value < 0.20 were entered in the multivariable logistic regression model. Both crude and adjusted odds ratios with the corresponding 95% CI were computed. The level of significance has been claimed based on the adjusted odds ratio with 95% CI and its p value of ≤0.05. Results The proportion of neonates experiencing near miss was obtained to be 32.2% with 95% CI (28, 36). Rural residence (AOR = 4.41; 95% CI: 2.57,7.55), incomplete ANC visit (AOR = 3.16; 95% CI: 1.90,5.25), primiparous (AOR = 2.55; 95% CI: 1.59,4.12), pregnancy-induced hypertension (AOR = 3.23; 95% CI: 1.19,8.78), premature rupture of membrane (AOR = 4.65; 95% CI: 1.70,12,73), cephalic-pelvic disproportion (AOR = 3.05; 95% CI: 1.32,7.01), and antepartum hemorrhage (AOR = 4.95; 95% CI: 1.89,12.96) were the independent predictors of neonatal near-miss. Conclusion and Recommendations. The proportion of neonatal near miss was found to be high in the study setting. Most of the determinants of near miss are modifiable obstetric-related factors. Hence, stakeholders need to consider the aforesaid factors while they design interventions.
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França KEXD, Vilela MBR, Frias PGD, Sarinho SW. EARLY NEONATAL NEAR MISS IN A UNIVERSITY HOSPITAL: COMPARATIVE CROSS-SECTIONAL STUDY. ACTA ACUST UNITED AC 2020; 39:e2019317. [PMID: 32996995 PMCID: PMC7518722 DOI: 10.1590/1984-0462/2021/39/2019317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare 2012 and 2016 data on early neonatal near miss indicators from Health Information Systems at a university hospital. METHODS This is a cross-sectional study conducted in 2012 and 2016. We considered early neonatal near misses the live births that presented one of the following risk conditions at birth: gestational age <33 weeks, birth weight <1,750g or 5-minute Apgar score <7, or Neonatal Intensive Care Unit (NICU) admission, and were alive until the 7th day of life. Data were collected from the Live Birth Information System, Hospital Information System, and Mortality Information System. We calculated the early neonatal mortality rate, neonatal near miss rate, severe neonatal outcome rate, early neonatal survival index, and early neonatal mortality index, compared by year of birth. RESULTS In 2012, 304 early neonatal near misses were registered, with a higher proportion of cases with very low birth weight and mothers who had zero to three prenatal visits. In 2016, the number of cases was 243, with a predominance of more NICU admissions. The incidence of early neonatal deaths and early neonatal near misses was higher in 2012 than in 2016. CONCLUSIONS Neonatal near miss indicators identified difference between years. The cases were more severe in 2012 and there were more NICU admissions in 2016.
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Bakari A, Bell AJ, Oppong SA, Bockarie Y, Wobil P, Plange-Rhule G, Goka BQ, Engmann CM, Adanu RM, Moyer CA. Neonatal near-misses in Ghana: a prospective, observational, multi-center study. BMC Pediatr 2019; 19:509. [PMID: 31870340 PMCID: PMC6927122 DOI: 10.1186/s12887-019-1883-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/11/2019] [Indexed: 01/24/2023] Open
Abstract
Background For every newborn who dies within the first month, as many as eight more suffer life-threatening complications but survive (termed ‘neonatal near-misses’ (NNM)). However, there is no universally agreed-upon definition or assessment tool for NNM. This study sought to describe the development of the Neonatal Near-Miss Assessment Tool (NNMAT) for low-resource settings, as well as findings when implemented in Ghana. Methods This prospective, observational study was conducted at two tertiary care hospitals in southern Ghana from April – July 2015. Newborns with evidence of complications and those admitted to the NICUs were screened for inclusion using the NNMAT. Incidence of suspected NNM at enrollment and confirmed near-miss (surviving to 28 days) was determined and compared against institutional neonatal mortality rates. Suspected NNM cases were compared with newborns not classified as a suspected near-miss, and all were followed to 28 days to determine odds of survival. Confirmed near-misses were those identified as suspected near-misses at enrollment who survived to 28 days. The main outcome measures were incidence of NNM, NNM:mortality ratio, and factors associated with NNM classification. Results Out of 394 newborns with complications, 341 (86.5%) were initially classified as suspected near-misses at enrollment using the NNMAT, with 53 (13.4%) being classified as a non-near-miss. At 28-day follow-up, 68 (17%) had died, 52 (13%) were classified as a non-near-miss, and 274 were considered confirmed near-misses. Those newborns with complications who were classified as suspected near-misses using the NNMAT at enrollment had 12 times the odds of dying before 28 days than those classified as non-near-misses. While most confirmed near-misses qualified as NNM via intervention-based criteria, nearly two-thirds qualified based on two or more of the four NNMAT categories. When disaggregated, the most predictive elements of the NNMAT were gestational age < 33 weeks, neurologic dysfunction, respiratory dysfunction, and hemoglobin < 10 gd/dl. The ratio of near-misses to deaths was 0.55: 1, yet this varied across the study sites. Conclusions This research suggests that the NNMAT is an effective tool for assessing neonatal near-misses in low-resource settings. We believe this approach has significant systems-level, continuous quality improvement, clinical and policy-level implications.
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Affiliation(s)
- Ashura Bakari
- Department of Child Health, Suntreso Government Hospital, Ghana Health Service, Kumasi, Ghana
| | - April J Bell
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, Medical School, University of Ghana, Accra, Ghana
| | - Yemah Bockarie
- Department of Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Priscilla Wobil
- Department of Child Health, Komfo Anokye Teaching Hospital / Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gyikua Plange-Rhule
- Department of Child Health, Komfo Anokye Teaching Hospital / Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bamenla Q Goka
- Department of Child Health, Medical School, University of Ghana, Accra, Ghana
| | - Cyril M Engmann
- Departments of Pediatrics and Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA.,Maternal, Newborn Childhealth and Nutrition, PATH, Seattle, WA, USA
| | - Richard M Adanu
- Population, Family and Reproductive Health Department, University of Ghana School of Public Health, Accra, Ghana
| | - Cheryl A Moyer
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA. .,Departments of Learning Health Sciences and Obstetrics & Gynecology, University of Michigan Medical School, 1111 E. Catherine Street, 231 Victor Vaughan Bldg, Ann Arbor, MI, 48109, USA.
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Kale PL, Silva KSD, Saraceni V, Coeli CM, Torres TZGD, Vieira FMDSB, Rocha NM, Fonseca SC. Life-threatening conditions at birth: an analysis of causes of death and survival estimate for under-five children in live birth cohorts. CAD SAUDE PUBLICA 2019; 35:e00186418. [PMID: 31411284 DOI: 10.1590/0102-311x00186418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/12/2019] [Indexed: 11/21/2022] Open
Abstract
Despite the reduction in under-five mortality, the causes are still mostly avoidable, and survival may be compromised by life-threatening conditions at birth. The study estimated the burden of life-threatening conditions at birth, neonatal near miss, and mortality, with an emphasis on avoidable causes, as well as under-five survival in live birth cohorts. This was a retrospective cohort study of live birth in the city of Rio de Janeiro, Brazil (2012-2016). The databases from the Brazilian Information System on Live Births and the Brazilian Mortality Information System were linked. Pragmatic criteria were used to define life-threatening conditions and near miss. Deaths were classified according to the Brazilian list of causes of avoidable deaths. Morbidity and mortality and survival indicators were estimated (Kaplan-Meier). Of the 425,505 live birth , 2.2% presented life-threatening conditions at birth. The under-five, infant and neonatal mortality rates were 0.01, 0.06, and 14.97 per 1,000 person-days, respectively. Avoidable, unclearly avoidable, and ill-defined causes accounted respectively for 61%, 35%, and 4% of the deaths. The risk of death from avoidable causes attributable to life-threatening conditions at birth was 97.6%. Survival was lower in newborns with life-threatening conditions compared to those without life-threatening conditions. The pragmatic criteria for life-threatening conditions determined the profile of proportional mortality by causes of death according to the three groups of causes in the Brazilian list of causes of avoidable deaths. Life-threatening conditions at birth increases the risk of morbidity and mortality in under-five children and raises the discussion on vulnerability and the need for care for these children and social support for their families.
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Affiliation(s)
- Pauline Lorena Kale
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Kátia Silveira da Silva
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Valéria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Cláudia Medina Coeli
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | - Narayani Martins Rocha
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Sandra Costa Fonseca
- Instituto de Saúde Coletiva, Universidade Federal Fluminense, Rio de Janeiro, Brasil
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Brasil DRPDA, Vilela MBR, França KEXD, Sarinho SW. NEONATAL MORBIDITY NEAR MISS IN TERTIARY HOSPITALS IN A CAPITAL OF NORTHEAST BRAZIL. ACTA ACUST UNITED AC 2019; 37:275-282. [PMID: 31291440 PMCID: PMC6868548 DOI: 10.1590/1984-0462/;2019;37;3;00011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/13/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To characterize near miss neonatal morbidity in tertiary hospitals in a capital city of Northeast Brazil based on Health Information Systems, and to identify differences regarding indicators of near miss cases, allowing the surveillance of newborns with risk of death. METHODS A cross-sectional study carried out in hospitals with neonatal intensive care unit, whose neonatal near miss cases in 2012 were identified from a deterministic linkage between the Mortality Information System and the Live Birth Information System. The biological variables of children, variables related to maternal characteristics and indicators of near miss were calculated by type of service and hospital. Biological variables of children, variables related to maternal characteristics and near miss indicators were calculated by service type and hospital and then compared by ratio difference test, parametric and non-parametric tests for measures of central tendency. RESULTS Of 24,254 live births, 2,098 cases of neonatal morbidity near miss were identified, most of them concentrated in the public hospitals (89.9%). The combination of birth weight and gestational age had the largest number of cases in both segments, public (43.5%) and private (46%). Variations in neonatal near miss indicators were observed between hospitals, which suggests assistance problems. CONCLUSIONS The concept of neonatal near miss, its applicability with data from Health Information Systems, and its indicators are a preliminary tool to monitor hospital care for newborns by signaling health services that require in-depth evaluation and investments for quality improvement.
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França KEXD, Vilela MBR, Frias PGD, Gaspar GDS, Sarinho SW. [Early neonatal near miss identified through health information systems]. CAD SAUDE PUBLICA 2018; 34:e00167717. [PMID: 30208179 DOI: 10.1590/0102-311x00167717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 04/13/2018] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to validate a definition to identify cases of early neonatal near miss using data from health information systems (SIS in Portuguese). This was a concurrent validation study focusing on three definitions for identification of cases of early neonatal near miss among live births in a university hospital in 2012. Three different definitions were applied to this live birth cohort using the criteria birth weight, gestational age, 5-minute Apgar score, admission to the neonatal intensive care unit, mechanical ventilation, and congenital malformations, in different combinations, considering the proposals in two Brazilian articles (Silva et al.; Pillegi-Castro et al.) and a third (SIS definition) with available data from health information systems. Cases were defined as infants that had survived the risk conditions as of the 7th day of life. For concurrent validation, the study adopted early neonatal deaths as the reference. Of the 2,097 live births studied, 33 died in the early neonatal period, and the number of cases of early neonatal near miss varied according to the definition used: 153 (Silva definition), 194 (Pileggi-Castro definition), and 304 (SIS definition). Sensitivity and specificity were 97% and 92.6%, respectively, according to the Silva definition, 90.9% and 90.6% according to the Pileggi-Castro definition, and 93.9% and 85.3% according to the SIS definition. The results show that the SIS definition has sensitivity and specificity close to the other definitions and suggest that it is possible to monitor early neonatal near miss using only data that are available in official health information systems.
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Bell AJ, Wynn LV, Bakari A, Oppong SA, Youngblood J, Arku Z, Bockarie Y, Adu J, Wobil P, Plange-Rhule G, Goka B, Adanu RM, Moyer CA. "We call them miracle babies": How health care providers understand neonatal near-misses at three teaching hospitals in Ghana. PLoS One 2018; 13:e0198169. [PMID: 29847603 PMCID: PMC5976150 DOI: 10.1371/journal.pone.0198169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 05/15/2018] [Indexed: 11/19/2022] Open
Abstract
Neonatal mortality is a significant problem in many low-resource countries, yet for every death there are many more newborns who suffer a life-threatening complication but survive. These "near-misses" are not well defined, nor are they well understood. This study sought to explore how health care providers at three tertiary care centers in Ghana (each with neonatal intensive care units (NICUs)) understand the term "near-miss." Eighteen providers from the NICUs at three teaching hospitals in Ghana (Korle Bu Teaching Hospital in Accra, Komfo Anokye Teaching Hospital in Kumasi, and Cape Coast Teaching Hospital in Cape Coast) were interviewed in depth regarding their perceptions of neonatal morbidity, mortality, and survival. Near the end of the interview, they were specifically asked what they understood the term "near-miss" to mean. Participants included nurses and physicians at various levels and with varying years of practice (mean years of practice = 9.33, mean years in NICU = 3.66). Results indicate that the concept of "near-misses" is not universally understood, and providers differ on whether a baby is a near-miss or not. Providers disagreed on the utility of a near-miss classification for clinical practice, with some suggesting it would be helpful to draw their attention to those at highest risk of dying, with others suggesting that the acuity of illness in a NICU means any baby could become a 'near-miss' at any moment. Further efforts are needed to standardize the definitions of neonatal near-misses, including developing criteria that are able to be assessed in a low-resource setting. In addition, further research is warranted to determine the practical implications of using a near miss tool in the process of providing care in a resource-limited setting and whether it might be best reserved as a retrospective indicator of overall quality of care provided.
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Affiliation(s)
- April J. Bell
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Lynette V. Wynn
- Medical School, University of Michigan, Ann Arbor, MI, United States of America
| | - Ashura Bakari
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Child Health Department, Suntresu Hospital, Ghana Health Service, Kumasi, Ghana
| | - Samuel A. Oppong
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Jessica Youngblood
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Zelda Arku
- Neonatal Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Yemah Bockarie
- Neonatal Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Joseph Adu
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Priscilla Wobil
- Child Health Department, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Bamenla Goka
- Department of Child Health, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | | | - Cheryl A. Moyer
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Medical School, University of Michigan, Ann Arbor, MI, United States of America
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
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