Critérios pragmáticos da definição de near miss neonatal: um estudo comparativo

Abstract

OBJECTIVE The objective of this study was to test the validity of the pragmatic criteria of the definitions of neonatal near miss, extending them throughout the infant period, and to estimate the indicators of perinatal care in public maternity hospitals.METHODS A cohort of live births from six maternity hospitals in the municipalities of São Paulo, Niterói, and Rio de Janeiro, Brazil, was carried out in 2011. We carried out interviews and checked prenatal cards and medical records. We compared the pragmatic criteria (birth weight, gestational age, and 5’ Apgar score) of the definitions of near miss of Pileggi et al., Pileggi-Castro et al., Souza et al., and Silva et al. We calculated sensitivity, specificity (gold standard: infant mortality), percentage of deaths among newborns with life-threatening conditions, and rates of near miss, mortality, and severe outcomes per 1,000 live births.RESULTS A total 7,315 newborns were analyzed (completeness of information > 99%). The sensitivity of the definition of Pileggi-Castro et al. was higher, resulting in a higher number of cases of near miss, Souza et al. presented lower value, and Pileggi et al. and de Silva et al. presented intermediate values. There is an increase in sensitivity when the period goes from 0–6 to 0–27 days, and there is a decrease when it goes to 0–364 days. Specificities were high (≥ 97%) and above sensitivities (54% to 77%). One maternity hospital in São Paulo and one in Niterói presented, respectively, the lowest and highest rates of infant mortality, near miss, and frequency of births with life-threatening conditions, regardless of the definition.CONCLUSIONS The definitions of near miss based exclusively on pragmatic criteria are valid and can be used for monitoring purposes. Based on the perinatal literature, the cutoff points adopted by Silva et al. were more appropriate. Periodic studies could apply a more complete definition, incorporating clinical, laboratory, and management criteria, including congenital anomalies predictive of infant mortality.

Ameaça à vida ao nascer: uma análise das causas de morte e estimativa de sobrevida de menores de cinco anos em coortes de nascidos vivos

“…There are no publications with the rate's population-based calculation to make a direct comparison with our results. In the maternity hospital with the most births in the city of Rio de Janeiro, and which almost exclusively serves the local birthing demand, the neonatal near miss rate by place of birth and based on the same pragmatic definition of near miss as in our study was 28.6 per thousand live births in 2011 12 .…”

"We call them miracle babies": How health care providers understand neonatal near-misses at three teaching hospitals in Ghana

“…[ 17 ] Current research by Kale and colleagues suggests that ‘pragmatic criteria’ (birthweight, gestational age, 5’ Apgar score) can be effectively used to define neonatal near-misses. [ 18 ] Such simple criteria allow for comparisons across varying socioeconomic situations and can be applied in the absence of technologically advanced screening and treatment modalities. [ 18 ]…”

“…[ 18 ] Such simple criteria allow for comparisons across varying socioeconomic situations and can be applied in the absence of technologically advanced screening and treatment modalities. [ 18 ]…”

Early Neonatal Near Miss in a University Hospital: Comparative Cross-Sectional Study

“…[9][10][11] Operational definitions of neonatal near miss, although not consensual, 5,8 are generally based on pragmatic criteria: birth weight, gestational age, and 5-minute Apgar score. 7,11,12 Other definitions are associated with the management variables used to save the baby's life, such as blood transfusion, surfactant use, phototherapy, mechanical ventilation, etc. 13,14 The use of neonatal near miss definitions to monitor care outcomes in health facilities is a challenge, but it can be easier with the variables available in the information systems maintained in daily services.…”

“…13,14 The use of neonatal near miss definitions to monitor care outcomes in health facilities is a challenge, but it can be easier with the variables available in the information systems maintained in daily services. 11,12 Neonatal near miss indicators are used for diagnosis, monitoring, and evaluation of neonatal hospital care and make it possible to compare the same or different health facilities over time. 7,9 The surveillance of neonatal near misses and the monitoring of their indicators may reveal weaknesses in health care and favor the promotion of public policies aimed at women, pregnant women, and newborns.…”