Abstract
Abstract Objectives: to evaluate factors associated with neonatal near miss and death in reference hospitals. Methods: this case-control study included 364 cases and 728 controls among 4,929 births. Cases were identified by Apgar < 7 at 5 minutes, weight < 1500 g, gestational age <32 weeks, mechanical ventilation or congenital malformation. After follow-up, outcomes were reclassified into: true controls, near miss and neonatal death. Hierarchically, variables with a p-value < 0.20 were included in the multiple logistic regression. Results: the neonatal near miss rate was 54.1 per 1,000 live births, and the near-miss-to-death ratio was 2.75. Between the control and near miss groups, the predictor variables were neonatal intensive care admission [OR = 35.6 (16.7 - 75.9)] and central venous access [OR= 74.8 (29.4 - 190.4)]. Between the control and death groups, neonatal intensive care admission [OR = 100.4 (18.8 - 537.0)] and central venous access [OR = 12.7 (3.7 - 43.2)] were significant. Between the near miss and death groups, only Apgar < 7 at 5 minutes [OR = 4.1 (1.6 - 10.6)] and vasoactive drug use [OR = 42.2 (17.1 - 104.5)] were significant. Conclusion: factors associated with a greater chance of near miss and/or neonatal death were: Apgar score <7 at 5 minutes, neonatal intensive care confinement, having central venous access, and use of vasoactive drugs.
Highlights
A neonatal near miss (NNM) is generally used to describe a newborn who survives a life-threatening condition during the first 28 days of life.[1]
We aimed to evaluate the factors associated with near miss morbidity and neonatal death in a public maternity hospital in the state of Ceará, a region still marked by high rates of neonatal and maternal morbidity and mortality
The role of several factors such as sociodemographic determinants, maternal characteristics and conditions, prenatal and delivery assistance, newborn health conditions, and neonatal care on neonatal near miss and deaths were studied. This augments the criteria for life-threatening conditions from the definition of Silva et al.[3]
Summary
A neonatal near miss (NNM) is generally used to describe a newborn who survives a life-threatening condition during the first 28 days of life.[1]. Among the 5.6 million children who died before their fifth birthday in 2016, approximately 46% (2.6 million) perished in the first month of life If this trend continues, 30 million of the 60 million children estimated to die between 2017 and 2030 will occur during the neonatal period. 30 million of the 60 million children estimated to die between 2017 and 2030 will occur during the neonatal period It is unacceptable for the scientific community that 7,000 of the 15,000 children dying every day have died in the neonatal period.[4] In Brazil, despite the decline in infant mortality, 42,049 and 25,555 child deaths were recorded in 2017 before the fifth year of life and in the neonatal period, respectively.[5]
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