A Call for Eminence Obstetrics Care by Way of “Neonatal Near Miss” Events (NNM): A Hospital-Based Case–Control Study

  • Bhavesh D. ShroffEmail author
  • Nittal H. Ninama
Original Article



A neonatal near miss (NNM) case would refer to an infant who nearly died but survived during birth or within 28 days of extra-uterine life. The near miss concept is being increasingly used as a tool to evaluate and improve the quality of care, especially obstetric care. All “near miss” should be inferred as free lesson and opportunities to improve the quality of service endowment.


A hospital based case control study was conducted in a tertiary care hospital of central Gujarat to measure factors associated with NNM events. Mothers of those newborns, who had been admitted for critical care, and survived, were included as cases, after their discharge. Controls were selected from same settings who were not falling into defined criteria of NNM. Various antenatal factors were compared among the two groups.


The number of neonatal near miss events were 291 (109 newborns with birth weight less than 1500 g, 169 APGAR score <7 and 13 with gestational age <30 weeks). The neonatal near miss rate was 86.7 per 1000 live births. Less number of antenatal visits, history of referral and hospitalisation during ante natal period were adversely associated with near miss events.


Incorporation of near miss events into the confidential enquiry system is worthwhile for corrective interventions like quality antenatal care, timely screening and referral of pregnant women into the primary health care system.


Neonatal near miss (NNM) APGAR score LBW Gestational age 



We are thankful to Dr. Vihang Mazumdar, Professor and Head, and Dr. R. K. Baxi, Professor, Community Medicine Department, whose constant supports in guiding this study have been of key importance. We are indebted to Dr. Suraj Kuria, Dr. Manoj Dave and Dr. Hiren Bhagora for their valuable support from the beginning of this study. We are thankful to the Heads of Department, Obstetrics and Gynaecology and Paediatrics and Medical Superintendent of the hospital for their continuous support throughout the process of data collection and for allowing study and to use data for the study. We are highly obliged to all the study participants, who willingly and enthusiastically participated in the study; without their support, the study would not have been possible.


This study was not funded by any kind of funding agency.

Compliance with Ethical Standards

Conflict of interest

Both authors declare that they have no conflict of interest.

Ethical Approval

Before starting enrolment of the participants, necessary clearances and permission were obtained from concerned authorities including Institutional Ethics committee for Human research (IECHR), Professor and Head of Paediatric Department, Professor and Head of Obstetrics and Gynaecology Department and Hospital Superintendent.

Informed Consent

At the time of data collection, the purpose of the study was clearly explained to the study subjects and they were also ensured of confidentiality of the information. The respondents were explained that they had the right to be involved or not to be involved in the study, and that non-involvement would not affect in any way the services they receive from the institutions. The participants were enrolled in the study only after taking written informed consent. The process of data collection did not pose any potential risk or harm to the participants as no kind of intervention or any interference with treatment was implicated.


  1. 1.
    India Newborn Action Plan. Ministry of health and family welfare, Government of India. September 2014.
  2. 2.
  3. 3.
    Say L. Neonatal near miss: a potentially useful approach to assess quality of newborn care. J Pediatr. 2010;86(1):1–2.CrossRefGoogle Scholar
  4. 4.
    Operational Guidelines of Child Death Review. Child health division, Ministry of health and family welfare. Government of India. August 2014
  5. 5.
    Pileggi C, Souza JP, Cecatti JG, et al. Neonatal near miss approach in the 2005. WHO Global Survey Brazil. J Pediatr. 2010;86(1):21–6.Google Scholar
  6. 6.
    The Millenium Development Goals Report 2005. [Internet]. 2005;32.
  7. 7.
    Pileggi-Castro C, Camelo JS, Perdoná GC, et al. Development of criteria for identifying neonatal near-miss cases: analysis of two WHO multicountry cross-sectional studies. BJOG. 2014;121(Suppl 1):110–8. Scholar
  8. 8.
    Fleiss J, Levin B, Cho M. Statistical methods for rates and proportions, formulas 3.18 & 3.19. London: Wiley; 2003.CrossRefGoogle Scholar
  9. 9.
    Oliveira TG, Freire PV, Moreira FT, et al. Apgar score and neonatal mortality in a hospital located in the southern area of São Paulo City, Brazil. Einstein (São Paulo). 2012;10(11):22–8.CrossRefGoogle Scholar
  10. 10.
    Lansky S, Friche AA, Silva AA, et al. Birth in Brazil survey: neonatal mortality, pregnancy and childbirth quality of care. Cadernos Saúde Públ. 2014;30:S192–207.CrossRefGoogle Scholar
  11. 11.
    Silva AA, Leite ÁJ, Lamy ZC, et al. Neonatal near miss in the birth in Brazil survey. Cadernos Saúde Públ. 2014;30:S182–91.CrossRefGoogle Scholar
  12. 12.
    Oyetunde MO. Pattern of diseases and care outcomes of neonates admitted in special care baby unit of University College Hospital, Ibadan, Nigeria from 2007 to 2011. IOSR J Nurs Health Sci. 2015;4(3):62–71.Google Scholar
  13. 13.
    Viswanath K, Ps R, Chakraborty A, et al. A community based case–control study on determinants of perinatal mortality in a tribal population of southern India. Rural Remote Health. 2015;15(3378):1–7.Google Scholar
  14. 14.
    Kassar SB, Melo AM, Coutinho SB, et al. Determinants of neonatal death with emphasis on health care during pregnancy, childbirth and reproductive history. J Pediatr. 2013;89(3):269–77.CrossRefGoogle Scholar

Copyright information

© Federation of Obstetric & Gynecological Societies of India 2018

Authors and Affiliations

  1. 1.Department of Community MedicineMedical College BarodaVadodaraIndia
  2. 2.Department of Community MedicineGMERS Medical CollegeHimmatnagarIndia

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