Independent consultant, Perinatology and Newborn Health, Geneva, Switzerland.
J Pediatr (Rio J). 2010 Jan-Feb;86(1):21-6. doi: 10.2223/JPED.1965.
To explore the use of the neonatal near miss concept as a tool to evaluate the quality of neonatal care, as 3 million early neonatal deaths occur every year around the world and the majority of these deaths are avoidable and take place in developing countries.
This is a secondary analysis of the 2005 WHO Global Survey on Maternal and Perinatal Health, a cross-sectional study, using data from 19 randomly selected Brazilian hospitals. A pragmatic definition of neonatal near miss was developed and tested. Near miss indicators were calculated.
Among the 15,169 live born infants included in this analysis, 424 presented at least one of the following conditions: very low birth weight, less than 30 gestational weeks at birth or an Apgar score at the 5th minute of life less than 7. According to the operational definition, these survivors from life-threatening conditions were considered neonatal near miss cases. The early neonatal mortality rate was 8.2/1,000 live births, the neonatal near miss rate was 21.4 neonatal near miss cases/1,000 live births. Substantial variations in the mortality among neonates with life-threatening conditions at birth were observed suggesting intra-hospital quality of care issues.
The near miss concept and indicators provided information that could be useful to evaluate the quality of care and set priorities for further assessments and health care improvement for newborn infants.
探讨将新生儿危重症概念作为评估新生儿护理质量的工具的应用，因为每年全世界有 300 万新生儿死于早产，而这些死亡大多是可以避免的，且发生在发展中国家。
这是对 2005 年世卫组织全球孕产妇和围产保健调查的二次分析，采用来自 19 家随机选择的巴西医院的数据进行横断面研究。制定并测试了新生儿危重症的实用定义。计算了危重症指标。
在这项分析中，共有 15169 例活产婴儿，其中 424 例出现以下至少一种情况：极低出生体重、出生时胎龄小于 30 周或出生后 5 分钟时的 Apgar 评分小于 7。根据操作定义，这些从危及生命的情况中幸存下来的婴儿被认为是新生儿危重症病例。早期新生儿死亡率为 8.2/1000 活产，新生儿危重症发生率为 21.4 例/1000 活产。在出生时有危及生命情况的新生儿中，死亡率存在很大差异，这表明医院内存在护理质量问题。
危重症概念和指标提供的信息可用于评估护理质量，并为进一步评估和改善新生儿保健制定优先事项。
