Neonatal Near Miss: the need for a standard definition and appropriate criteria and the rationale for a prospective surveillance system

Abstract

In Latin American, there is currently a regional action with the main purposes of putting the concept of severe neonatal morbidity in practice and formulating proposals for interventions. A general overview of neonatal health conditions, including morbidity and mortality, is provided to update regional knowledge on the topic. An example of the development and implementation of the concept of maternal near miss is also provided, followed by results from a systematic review covering all previously published studies on Neonatal Near Miss. Finally, some proposals for building a common concept on the topic and for launching a prospective surveillance study are presented. A Neonatal Near Miss is a neonate who had a severe morbidity (organ dysfunction or failure) but who survived this condition within the first 27 days of life. The pragmatic criteria recommended to be used are as follows: birth weight below 1700 g, Apgar score below 7 at 5 minutes of life and gestational age below 33 weeks. As a proxy for organ dysfunction, the following management criteria are also confirmed: parenteral therapeutic antibiotics; nasal continuous positive airway pressure; any intubation during the first 27 days of life; phototherapy within the first 24 h of life; cardiopulmonary resuscitation; the use of vasoactive drugs, anticonvulsants, surfactants, blood products and steroids for refractory hypoglycemia and any surgical procedure. Although this study starts from a regional perspective, this topic is clearly globally relevant. All nations, especially low and middle-income countries, could benefit from the proposed standardization.

Neonatal near miss determinants at a maternity hospital for high-risk pregnancy in Northeastern Brazil: a prospective study

“…NNM was defined as a neonate who had suffered a life-threatening condition but survived the first 27 days of life [5]. Two sets of criteria that are recommended by the CLAP were used to identify newborn infants at a high risk of death at birth: pragmatic criteria (gestational age at birth less than 33 weeks; birth weight <  1750 g; and 5-min Apgar score < 7) and management criteria (parenteral antibiotics for up to 7 days before 28 days of age; use of a continuous positive airway pressure (CPAP) device; any intubation lasting for up to 7 days before 28 days of age; phototherapy within the first 24 h of life; cardiopulmonary resuscitation; use of vasoactive drugs, anticonvulsants, surfactant, or blood-derived products or use of steroids to treat refractory hypoglycemia; and any surgical procedure) [5].…”

“…In response to this scenario, in 2015, the Latin American Centre of Perinatology (Centro Latino-Americano de Perinatologia - CLAP) led discussions and proposals aiming at establishing a standardized definition of NNM [5] based on the results of previous studies on the subject [4–6]. The CLAP suggests defining NNM as any newborn infant who exhibited pragmatic and/or management criteria and survived the first 27 days of life.…”

A populational based study on the prevalence of neonatal near miss in a city located in the South of Brazil: prevalence and associated factors

“…[1][2][3][4][5] Studies show that the number of newborn babies who survived such morbidities affect is approximately 3 to 6 times greater than those who died. 1,3,6 Thus, its use is considered of great interest and may bring advantages in relation to neonatal mortality, since severe morbidities that affect newborn babies without causing death, in general, do not have visibility in the health statistics.…”

“…Therefore, they are not the object of interventions in the public health context, especially regarding the quality of care in the area of maternal and child health. 1,2,5,6 In low and middle income countries, the reduction of neonatal component of infant mortality has occurred in a pace below the expected. 7 In Brazil, between 1990 and 2013, the coefficient decrease on infant mortality rate was 76% and the neonatal and post-neonatal mortality components were, respectively, 71% and 83%.…”

“…1,5,6 In Brazil, morbidity has recently been studied and the diversity of the proposed criteria has impacts on its magnitude. 1,5,6 Using data from Nascer no Brasil (Born in Brazil) research, Silva et al 3 tested 19 demographic and socioeconomic variables related to health services and selected 5 considered to be predictors of neonatal death. Based on validated criteria of Silva et al 3 study, this study aims to identify the prevalence of neonatal near miss morbidity in the city of Joinville, SC and the associated factors.…”