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Development of criteria for identifying neonatal near‐miss cases: analysis of two WHO multicountry cross‐sectional studies
Author(s) -
PileggiCastro C,
Camelo Jr JS,
Perdoná GC,
MussiPinhata MM,
Cecatti JG,
Mori R,
Morisaki N,
Yunis K,
Vogel JP,
Tunçalp Ö,
Souza JP
Publication year - 2014
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12637
Subject(s) - medicine , cross sectional study , odds ratio , gestational age , apgar score , pediatrics , obstetrics , pregnancy , pathology , biology , genetics
Objective To develop and test markers of neonatal severe morbidity for the identification of neonatal near‐miss cases. Design This is a database analysis of two W orld H ealth O rganization cross‐sectional studies: the G lobal S urvey on M aternal and P erinatal H ealth ( WHOGS ) and the M ulticountry S urvey on M aternal and N ewborn H ealth ( WHOMCS ). Setting The WHOGS was performed in 373 health facilities in 24 countries (2004–2008). The WHOMCS was conducted in 359 health facilities in 29 countries (2010–2011). Population Data were collected from hospital records of all women admitted for delivery and their respective neonates. Methods Pragmatic markers (birthweight <1750 g, A pgar score at 5 minutes <7, and gestational age <33 weeks) were developed with WHOGS data and validated with WHOMCS data. The diagnostic accuracy of neonatal characteristics and management markers of severity was determined in the WHOMCS . Results This analysis included 290 610 liveborn neonates from WHOGS and 310 436 liveborn neonates from WHOMCS . The diagnostic accuracy of pragmatic and management markers of severity for identifying early neonatal deaths was very high: sensitivity, 92.8% (95% CI 91.8–93.7%); specificity, 92.7% (95% CI 92.6–92.8%); positive likelihood ratio, 12.7 (95% CI 12.5–12.9); negative likelihood ratio, 0.08 (95% CI 0.07–0.09); diagnostic odds ratio, 163.4 (95% CI 141.6–188.4). A positive association was found between the frequency of neonatal near‐miss cases and Human Development Index. Conclusion Newborn infants presenting selected markers of severity and surviving the first neonatal week could be considered as neonatal near‐miss cases. This definition and criteria may be seen as a basis for future applications of the near‐miss concept in neonatal health. These tools can be used to inform policy makers on how best to apply scarce resources for improving the quality of care and reducing neonatal mortality.