Morbidade neonatal near miss em um serviço de perinatologia

OBJETIVO: identificar os casos de morbidade neonatal near miss em um serviço de Perinatologia do estado do Maranhão. MÉTODO: pesquisa descritiva e transversal de abordagem quantitativa, realizada a partir da análise dos dados de recém-nascidos internados na Unidade Neonatal de um Serviço de Perinatologia no período de 2017 a 2018. As análises estatísticas foram processadas no programa estatístico STATA versão 14.0. RESULTADOS: o peso ao nascer <1500g foi a variável que mais classificou casos de near miss neonatal, seguido pela variável de idade gestacional <34 semanas. Os resultados obtidos demonstraram associação entre hipertensão gestacional e peso ao nascer; hipertensão gestacional e idade gestacional ao nascer; parto cesáreo e Apgar no 5º minuto ≥ 7; parto cesáreo e sexo masculino. CONCLUSÃO: observou-se a importância da abordagem near miss neonatal para a compreensão ampliada da morbimortalidade neonatal e fatores associados.

A Case-Control Study on the Predictors of Neonatal Near-Miss: Implications for Public Health Policy and Practice

Purpose: Neonatal near miss (NNM) allows for the detection of risk factors associated with serious newborn complications and death, the prevention of which could reduce neonatal mortality. This study was conducted with the objective of identifying predictors for NNM in a tertiary hospital in Bangalore city.Methods: This was an unmatched case-control study involving 120 NNM cases and 120 controls. NNM was determined using Pileggi-Castro’s pragmatic and management criteria. Data was collected from in-patient hospital records and interviews of postpartum mothers. Multiple logistic regression of exposure variables was performed to calculate adjusted odds ratio (AOR) with 95% confidence interval (CI).Results: Significant predictors were maternal age ≥30 years (AOR, 5.32; 95% CI, 1.12 to 9.29; P=0.041), inadequate antenatal care (ANC) (AOR, 8.35; 95% CI, 1.98 to 51.12; P=0.032), <3 ultrasound scans during pregnancy (AOR, 12.5; 95% CI, 1.60 to 97.27; P=0.016), maternal anaemia (AOR, 18.96; 95% CI, 3.10 to 116.02; P=0.001), and any one obstetric complication (hypertensive disorder in pregnancy, diabetes in pregnancy, preterm premature rupture of membranes, prolonged labour, obstructed labour, malpresentation) (AOR, 4.34; 95% CI, 1.26 to 14.95; P=0.02).Conclusion: The predictors of NNM identified has important implications for public health policy and practice whose modifications can improve NNM. These include expanding essential ANC package to include ultrasound scans, ensuring World Health Organization recommendations of eight ANC visits, capacity building at all levels of health care to strengthen routine ANC and obstetric care for effective screening, referral and management of obstetric complications.

Prevalence of neonatal near miss and associated factors in Nepal: a cross-sectional study

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.

The magnitude of neonatal near miss and associated factors among live births in public hospitals of Jimma Zone, Southwest Ethiopia, 2020: A facility-based cross-sectional study

Background Neonates with severe complications at birth or during the neonatal period who nearly died but survived constitute neonatal near miss (NNM) cases. Identifying NNM cases and correcting contributing factors are of the utmost importance to get relevant controls for neonatal deaths. However, limited studies are assessing the prevalence of NNM and associated factors with NNM cases in Ethiopia. So, this study is aimed at assessing the magnitude of neonatal near miss and associated factors among live births in public hospitals of Jimma zone, southwest Ethiopia, 2020. Methods A facility-based cross-sectional study was conducted among 260 neonates from April 1–30 / 2020. Face to face interviewer-administered structured questionnaire was used to collect data from the mothers and a standard checklist was used for their neonates. The data was encoded and entered into Epi-Data version 4.2 and exported to SPSS version 23 for analysis. Independent variables with marginal associations (p-value <0.25) in the bivariable analysis were eligible for multivariable logistic regression analysis to detect an association with outcome variables. Finally, adjusted odds ratios (AOR) with 95% CI were used to estimate the strength of associations, and statistical significance was declared at a p-value < 0.05. Result The magnitude of NNM was 26.7% with [95%CI: 21.6–32.5]. Hypertension during pregnancy [AOR: 3.4; 95%CI: 1.32–8.88], mode of delivery [AOR: 3.32; 95%CI: 1.48–7.45], Obstructed labor [AOR: 2.95; 95%CI: 1.32–6.45] and non-vertex fetal presentation during delivery [AOR: 4.61; 95%CI: 2.16–9.84] were identified as significantly predictors of NNM. Conclusion and recommendation Over a quarter of the neonates were with NNM cases, which is relatively higher than the report of studies done in other countries. Hypertension during pregnancy, cesarean delivery, prolonged labor, and non-vertex fetal presentation were all found to increase the likelihood of NNM. Therefore, concerted efforts are needed from local health planners and health care providers to improve maternal health care services especially in early identification of the complications and taking appropriate management.