Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle (UON), University drive, Callaghan, NSW 2308, Australia.
Early Hum Dev. 2021 May;156:105343. doi: 10.1016/j.earlhumdev.2021.105343. Epub 2021 Mar 3.
Neonatal Near Miss (NNM) is a situation where a newborn narrowly survived the neonatal period. It has been hypothesized that identifying factors that contribute to the occurrence of NNM and taking timely interventions could enhance the quality of newborn care. However, there is limited evidence in Australia. This study aimed to identify the determinants of NNM in Australia.
Data from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) were linked with state-based Perinatal Data Collections (PDC) for 3655 mothers and 5526 newborns who were born between 01 January 2007 and 31 December 2015. A newborn was considered as a near miss case if presented with any of the pragmatic criteria (gestational age <32 weeks, birth weight <1500 g, five-minute Apgar score <7) and survived the neonatal period. A multilevel multivariable logistic regression model was used to identify the determinants of NNM.
Of the total 5526 live births included in this study, 95 live births met the criteria for NNM, corresponding to an incidence of 17.2 per 1000 live births. After controlling for potential confounders, maternal age 31-34 years (AOR = 2.57; 95% CI: 1.05, 6.30) and 35 years and above (AOR = 4.03; 95% CI: 1.58, 10.31), caesarean section (AOR = 2.24; 95% CI: 1.09, 4.57), and gestational hypertension (AOR = 2.63; 95% CI: 1.21, 5.71) increased the odds of NNM.
Inclusion of NNM evaluations into newborn care and early screening and interventions for women who become pregnant at older age and those with pregnancy complications could improve the quality of newborn care and reduce neonatal morbidity.
新生儿近危（NNM）是指新生儿在新生儿期勉强存活的情况。有人假设，确定导致 NNM 发生的因素并及时采取干预措施，可以提高新生儿护理质量。然而，澳大利亚的相关证据有限。本研究旨在确定澳大利亚 NNM 的决定因素。
将澳大利亚妇女健康纵向研究（ALSWH）1973-78 年队列的数据与基于州的围产期数据收集（PDC）进行链接，共涉及 3655 名母亲和 5526 名于 2007 年 1 月 1 日至 2015 年 12 月 31 日期间出生的新生儿。如果新生儿符合任何实用标准（胎龄<32 周、出生体重<1500g、5 分钟 Apgar 评分<7）且在新生儿期存活，则被视为近危病例。使用多水平多变量逻辑回归模型来确定 NNM 的决定因素。
在本研究纳入的 5526 例活产儿中，有 95 例符合 NNM 标准，发生率为每 1000 例活产儿 17.2 例。在控制了潜在混杂因素后，母亲年龄 31-34 岁（OR=2.57；95%CI：1.05，6.30）和 35 岁及以上（OR=4.03；95%CI：1.58，10.31）、剖宫产（OR=2.24；95%CI：1.09，4.57）和妊娠高血压（OR=2.63；95%CI：1.21，5.71）增加了 NNM 的发生几率。
将 NNM 评估纳入新生儿护理中，并对高龄产妇和有妊娠并发症的孕妇进行早期筛查和干预，可以提高新生儿护理质量，降低新生儿发病率。
