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Analysis of Maternal Factors Impacting Neonatal Near Miss (NNM) Events: A Tertiary Centre Experience

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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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Abbreviations

NNM:

Neonatal near miss

SDG:

Sustainable Development Goals

WHO:

World Health Organization

NND:

Neonatal death

FGR:

Foetal growth retardation

PPROM:

Preterm premature rupture of membranes

References

  1. World Health Orgainization. Millennium Development Goals (MDGs). WHO. 2018, February 19 https://www.who.int/news-room/fact-sheets/detail/millennium-development-goals-(mdgs)

  2. Surve S, Chauhan S, Kulkarni R. Neonatal near miss review: tracking its conceptual evolution and way forward. Curr Pediatr Res. 2017;21:264–71.

    Google Scholar 

  3. World Health Organization. Every Newborn: an action plan to end preventable deaths. WHO 2014 https://www.who.int/maternal_child_adolescent/documents/every-newborn-action-plan/en/

  4. Shroff BD, Ninama NH. A call for eminence obstetrics care by way of “Neonatal Near Miss” events (NNM): a hospital-based case-control study. J Obstet Gynaecol India. 2019;69(1):50–5. https://doi.org/10.1007/s13224-018-1093-9.

    Article  PubMed  Google Scholar 

  5. United Nations Transforming our World: The 2030 agenda for sustainable development. Sustainable development goals knowledge platform. 2015 https://sustainabledevelopment.un.org/post2015/transformingourworld/publication

  6. de Lima T, Katz L, Kassar SB, et al. Neonatal near miss determinants at a maternity hospital for high-risk pregnancy in Northeastern Brazil: a prospective study. BMC Pregnancy Childbirth. 2018;18(1):401. https://doi.org/10.1186/s12884-018-2020-x.

    Article  PubMed  PubMed Central  Google Scholar 

  7. World Health Organization. The WHO near-miss approach. World Health Organization Sexual and Reproductive Health. n.d. Retrieved April 14, 2021, from https://www.who.int/reproductivehealth/topics/maternal_perinatal/nmconcept/en/#:~:text=Near%2Dmiss%20concept,miss%20concept%20in%20maternal%20health.

  8. de Lima T, Amorim MM, Buainain Kassar S, et al. Maternal near miss determinants at a maternity hospital for high-risk pregnancy in northeastern Brazil: a prospective study. BMC Pregnancy Childbirth. 2019;19(1):271. https://doi.org/10.1186/s12884-019-2381-9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pileggi-Castro C, Camelo JS, Jr Perdoná GC, et al. Development of criteria for identifying neonatal near-miss cases: analysis of two WHO multicountry cross-sectional studies. BJOG : An Int J Obst Gynaecol, 2014; 121 Suppl 1: 110–118. doi: https://doi.org/10.1111/1471-0528.12637

  10. Avenant T. Neonatal near miss: a measure of the quality of obstetric care. Best Practice Res Clinic Obst Gynaecol. 2009;23(3):369–74. https://doi.org/10.1016/j.bpobgyn.2008.12.005.

    Article  Google Scholar 

  11. Pattinson RC. MRC maternal and infant health care strategies research unit. Facts, Views Vision ObGyn. 2010;2(4):217–8.

    Google Scholar 

  12. Adeniran AS, Ocheke AN, Nwachukwu D, et al. Non-obstetric causes of severe maternal complications: a secondary analysis of the Nigeria near-miss and maternal death survey. BJOG : An Int J Obst Gynaecol. 2019;126(Suppl 3):41–8. https://doi.org/10.1111/1471-0528.15623.

    Article  Google Scholar 

  13. Nakimuli A, Mbalinda SN, Nabirye RC, et al. Still births, neonatal deaths and neonatal near miss cases attributable to severe obstetric complications: a prospective cohort study in two referral hospitals in Uganda. BMC Pediatr. 2015;15:44. https://doi.org/10.1186/s12887-015-0362-3.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Brasil D, Vilela M, França K, et al. Neonatal morbidity near miss in tertiary hospitals in a capital of Northeast Brazil. Revista paulista de pediatria: orgao oficial da Sociedade de Pediatria de Sao Paulo. 2019;37(3):275–82. https://doi.org/10.1590/1984-0462/;2019;37;3;00011.

    Article  Google Scholar 

  15. Santos JP, Pileggi-Castro C, Camelo JS Jr, et al. Neonatal near miss: a systematic review. BMC Pregnancy Childbirth. 2015;15:320. https://doi.org/10.1186/s12884-015-0758-y.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Santos JP, Cecatti JG, Serruya SJ, et al. Neonatal Near Miss: the need for a standard definition and appropriate criteria and the rationale for a prospective surveillance system. Clinics (Sao Paulo, Brazil), 2015; 70(12): 820–826. doi: https://doi.org/10.6061/clinics/2015(12)10

  17. Manandhar S, Manandhar D, Adhikari D, et al. Neonatal near miss cases of different health facilities. J Nepal Paediatric Soc. 2014;34(2):115–8. https://doi.org/10.3126/jnps.v34i2.9880.

    Article  Google Scholar 

  18. Kale PL, Jorge M, Laurenti R, et al. Pragmatic criteria of the definition of neonatal near miss: a comparative study. Rev Saude Publica. 2017;51:111. https://doi.org/10.11606/S1518-8787.2017051006587.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

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No source of funding has been received for this project.

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Authors and Affiliations

  1. Minimally Invasive Gynecologic Surgery, Oyster Hospital, Goregaon, Mumbai, India

    Maitreyee Parulekar MBBS, MS (OBGY)

  2. Department of Obstetrics and Gynaecology, Seth G.S Medical College and K.E.M Hospital, Parel, Mumbai, India

    Harshada Thakur MBBS, MS (OBGY) & Padmaja Samant MBBS, MS (OBGY)

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  1. Maitreyee Parulekar MBBS, MS (OBGY)
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  2. Harshada Thakur MBBS, MS (OBGY)
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  3. Padmaja Samant MBBS, MS (OBGY)
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Correspondence to Maitreyee Parulekar MBBS, MS (OBGY).

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Dr. Maitreyee Parulekar MBBS, MS (OBGY), Fellow in Minimally Invasive Gynecologic Surgery, Oyster Hospital, Goregaon, Mumbai. Dr. Harshada Thakur MBBS, MS (OBGY), Assistant Professor, Department of Obstetrics and Gynaecology, Seth G.S Medical College and K.E.M Hospital. Dr. Padmaja Samant MBBS, MS (OBGY), Additional Professor, Department of Obstetrics and Gynaecology, Seth G.S Medical College & K.E.M Hospital, Parel, Mumbai.

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Parulekar, M., Thakur, H. & Samant, P. Analysis of Maternal Factors Impacting Neonatal Near Miss (NNM) Events: A Tertiary Centre Experience. J Obstet Gynecol India 72 (Suppl 1), 75–82 (2022). https://doi.org/10.1007/s13224-021-01554-2

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  • DOI: https://doi.org/10.1007/s13224-021-01554-2

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