Neonatal near miss approach in the 2005 WHO Global Survey Brazil.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Independent consultant, Perinatology and Newborn Health, Geneva, Switzerland. cynthiapileggi@gmail.com
Cynthia
C
Pileggi
João P
JP
Souza
Jose G
JG
Cecatti
Anibal
A
Faúndes
D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000453:epidemiology*; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight / Q000502:physiology; D007231:Infant, Newborn; D050498:Live Birth / Q000453:epidemiology; D008427:Maternal Health Services / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D011247:Pregnancy; D014944:World Health Organization