Parulekar Maitreyee, Thakur Harshada, Samant Padmaja
Minimally Invasive Gynecologic Surgery, Oyster Hospital, Goregaon, Mumbai India.
Department of Obstetrics and Gynaecology, Seth G.S Medical College and K.E.M Hospital, Parel, Mumbai India.
J Obstet Gynaecol India. 2022 Aug;72(Suppl 1):75-82. doi: 10.1007/s13224-021-01554-2. Epub 2021 Sep 8.
To find out the incidence of neonatal near miss (NNM) cases in comparison with the neonatal deaths and to study the different antenatal and intrapartum maternal variables and system-related delays influencing these events.
This is a descriptive retrospective study conducted over a year (2018-2019) at a tertiary referral hospital in India, where NNM cases were selected as per 'pragmatic criteria', and detailed maternal and neonatal biological variables and near miss indicators were procured from the medical record books and analysed.
Out of 6383 live births and 231 neonatal deaths in the hospital during the study period, 810 NNM cases were identified born to 710 mothers, i.e. 3.5 cases for each neonatal death. Birth weight and gestational age in combination contributed to the maximum number of cases-383 (47.28%). The most common reason for referral was threatened pre-term/PPROM with non-availability of NICU-197 cases (38.3%) out of 514 referrals. Out of 710 mothers, 529 (74.5%) had at least one comorbidity at the time of presentation. The most common comorbidity was anaemia in 267 women followed by hypertensive disorder of pregnancy-in 251 cases. Primary delay contributed to 54% of all delays in the study.
NNM can be used as an effective tool for quality control and audits to effectively reduce maternal and neonatal morbidity and mortality but needs more research to establish a standardized definition and criteria for selection of cases.
查明新生儿危殆病例（NNM）的发生率，并与新生儿死亡情况进行比较，同时研究影响这些事件的不同产前和产时母体变量以及与系统相关的延误情况。
这是一项在印度一家三级转诊医院进行的为期一年（2018 - 2019年）的描述性回顾性研究，按照“实用标准”选择NNM病例，并从病历中获取详细的母体和新生儿生物学变量以及危殆指标进行分析。
在研究期间，该医院6383例活产中有231例新生儿死亡，共识别出810例NNM病例，其母亲为710人，即每例新生儿死亡对应3.5例NNM病例。出生体重和孕周共同导致的病例数最多，为383例（47.28%）。转诊的最常见原因是早产/未足月胎膜早破且无新生儿重症监护病房（NICU），在514例转诊病例中有197例（38.3%）。在710名母亲中，529名（74.5%）在就诊时有至少一种合并症。最常见的合并症是267名女性患贫血，其次是251例妊娠高血压疾病。在本研究中，主要延误占所有延误的54%。
NNM可作为质量控制和审核的有效工具，以有效降低孕产妇和新生儿的发病率和死亡率，但需要更多研究来建立病例选择的标准化定义和标准。
