Delays in obstetric care increase the risk of neonatal near-miss morbidity events and death: a case-control study

Abstract

Background: To evaluate the association between delays in obstetric care and neonatal near-miss mortality events and death in a public maternity referral center. Methods: This case-control study enrolled 142 neonates, meeting the near-miss criteria of 5-min Apgar < 7, weight < 1500 g, gestational age < 32 weeks, and use of mechanical ventilation or congenital malformation, as well as 284 controls (without the near-miss criteria), at a ratio of 1:2. After follow-up, the following outcomes were reclassified: survival of the neonatal period without the near-miss criteria (true "controls"), "near-miss," and "neonatal death." Maternal sociodemographic characteristics, prenatal care, and pregnancy resolution were evaluated. Pearson's chi-square and Fisher's exact tests were used. Simple logistic regression was performed to determine the association between the three delay factors with near-miss outcomes and/or neonatal death. The variables that had maintained values of p < 0.05 were subjected to multinomial logistic regression. Results: Comparisons revealed the following associations: for controls and near-miss events, delayed access to health services due to a lack of specialized services (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8-5.1) and inappropriate conduct with the patient (OR, 12.1; 95% CI, 1.3-108.7); for controls and death, absent or inadequate prenatal care (OR, 3.3; 95% CI, 1.6-7.1) and delayed access to health services due to a lack of specialized services (OR, 2.5; 95% CI, 1.1-5.6); and for near-miss events and death, absent or inadequate prenatal care (OR, 2.2; 95% CI, 1.0-5.0). Logistic regression for the combined outcome (near-miss plus neonatal deaths) revealed absent or inadequate prenatal care (OR, 1.9; 95% CI, 1.2-2.8), lack of specialized services (OR, 2.8; 95% CI, 1.7-4.5), and improper conduct with the patient (OR, 10.6; 95% CI, 1.2-91.8). Conclusions: The delays in obstetric care associated with the presence of near-miss and/or neonatal death included absent or inadequate prenatal care, delayed access to health services due to a lack of specialized services, and inappropriate conduct with the patient.

Magnitude of neonatal near miss in public hospitals in Eastern Ethiopia: A cross-sectional study

“… 31 , 32 Moreover, our finding shows those neonates born to mothers with no antenatal care were more likely to develop NNM in agreement with other studies. 9 , 10 , 16 , 28 Having prenatal care will enable women to get information about their pregnancy, knowledge regarding danger signs, and where to seek care when needed, 33 , 34 thus reducing risk of NNM. We also found that complications in pregnancy or labor and delivery are significant contributors of NNM.…”

Determinants of neonatal near miss among neonates admitted to public hospitals in Southern Ethiopia, 2021: A case-control study

“…Third delay(Delay in obtaining adequate and appropriate treatment while the mother arrived in a health facility) was a significant determinant of NNM. This finding was backed up by a study conducted in Brazil, which indicated that the third delay contributed significantly to maternal and newborn risks [60,61]. Lack of qualified and skilled personnel, insufficient staff, limited availability of medicine and equipment, generally poor conditions of the facilities, and poor attitudes and treatment on the part of medical workers are all possible reasons for the delay, and stakeholders working on maternal and neonatal health should place a strong emphasis on overcoming these impediments [45].…”

Associated factors of neonatal near miss among newborns of adolescent mothers in Brazil

“…In medium and small size municipalities of the Jequitinhonha Valley (Minas Gerais state) and the Northeast and North regions of Brazil, an association was found between not being associated to a maternity hospital during prenatal and child death (OR = 1.28; 95% CI = 1.02-1.61) (24) . In the state of Ceará, Brazil, a study has shown that late access by pregnant adolescents to specialized services leads to neonatal near miss (OR = 3.0; 95% CI = 1.8-5.1) in comparison with adults (25) . Regardless of the maternal age group, better perinatal results are obtained in hospitals with adequate material and human resources, in addition to assertive care practices towards pregnant and puerperal women and their newborns (23) , suggesting the importance of an association between adolescents and an appropriate hospital to meet their needs.…”