Shroff Bhavesh D, Ninama Nittal H
1Department of Community Medicine, Medical College Baroda, Vadodara, Gujarat India.
Department of Community Medicine, GMERS Medical College, Himmatnagar, Gujarat India.
J Obstet Gynaecol India. 2019 Feb;69(1):50-55. doi: 10.1007/s13224-018-1093-9. Epub 2018 Feb 14.
A neonatal near miss (NNM) case would refer to an infant who nearly died but survived during birth or within 28 days of extra-uterine life. The near miss concept is being increasingly used as a tool to evaluate and improve the quality of care, especially obstetric care. All "near miss" should be inferred as free lesson and opportunities to improve the quality of service endowment.
A hospital based case control study was conducted in a tertiary care hospital of central Gujarat to measure factors associated with NNM events. Mothers of those newborns, who had been admitted for critical care, and survived, were included as cases, after their discharge. Controls were selected from same settings who were not falling into defined criteria of NNM. Various antenatal factors were compared among the two groups.
The number of neonatal near miss events were 291 (109 newborns with birth weight less than 1500 g, 169 APGAR score <7 and 13 with gestational age <30 weeks). The neonatal near miss rate was 86.7 per 1000 live births. Less number of antenatal visits, history of referral and hospitalisation during ante natal period were adversely associated with near miss events.
Incorporation of near miss events into the confidential enquiry system is worthwhile for corrective interventions like quality antenatal care, timely screening and referral of pregnant women into the primary health care system.
新生儿濒死病例是指在出生时或宫外生活28天内几乎死亡但存活下来的婴儿。濒死概念正越来越多地被用作评估和改善护理质量，尤其是产科护理质量的工具。所有“濒死”情况都应被视为免费的经验教训以及提升服务质量的机会。
在古吉拉特邦中部的一家三级护理医院开展了一项基于医院的病例对照研究，以衡量与新生儿濒死事件相关的因素。那些因重症监护入院且存活下来的新生儿的母亲在出院后被纳入病例组。对照组从不符合新生儿濒死既定标准的同一环境中选取。对两组之间的各种产前因素进行了比较。
新生儿濒死事件的数量为291例（109例出生体重低于1500克的新生儿，169例阿氏评分<7分，13例孕周<30周）。新生儿濒死率为每1000例活产86.7例。产前检查次数较少、产前转诊和住院史与濒死事件呈负相关。
将濒死事件纳入保密调查系统对于诸如高质量产前护理、及时筛查以及将孕妇转诊至初级卫生保健系统等纠正性干预措施而言是值得的。
