title: Identification of neonatal near miss by systematic screening for metabolic acidosis at birth.
abstract: OBJECTIVE
  To evaluate the relevance of systematic screening for neonatal metabolic acidosis at birth as part of perinatal audit.
  
  
  METHODS
  For every baby, born in Ziekenhuis Oost Limburg, Genk Belgium between 1/1/2010 and 31/12/2010, cord blood was analysed to diagnose metabolic acidosis, defined as arterial or venous pH ≤ 7.05 or 7.17 respectively, in association with base excess of ≤ -10 mmol/L. Three observers identified indicators for suboptimal peripartal care with likely contribution to metabolic acidosis. In a multidisciplinary consensus meeting, these indicators were classified into 5 categories : (a) fetal monitoring error (b) labour management error, (c) instrumental vaginal delivery for fetal distress within 2 h of second stage, (d) non-obstetric medical complications, (e) preterm births or accidental cases at term.
  
  
  RESULTS
  In a total of 2117 neonates, there were 11 intra-uterine, 1 intrapartum and 3 early neonatal deaths, bringing early perinatal mortality rate at 7.1‰. Metabolic acidosis was identified in 23 (1.1%) babies, of which 21 (91.3%) left hospital in good clinical condition. Two babies (0.9‰), born in category c, had chronic neurologic symptoms.
  
  
  CONCLUSIONS
  Systematic screening for neonatal metabolic acidosis caused a 2.5-fold increase of case identifications eligible for perinatal audit and opened perspectives towards rationalised improvement of perinatal care, in addition to the information obtained from cases of perinatal mortality. Next to indicators of perinatal mortality, perinatal audit programs should include neonatal metabolic acidosis as an extra parameter for quality assessment of perinatal care.
  
  
  CONCLUSIONS
  Adding cases of near-miss neonatal morbidity to perinatal mortalities in perinatal audit programs increases opportunities for improvement of perinatal care.
authors.affiliation: Dept. Obstetrics and Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Bonnaerens
authors.affiliation: Dept. Obstetrics and Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Thaens
authors.affiliation: Dept. Obstetrics and Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Mesens
authors.affiliation: Dept. Obstetrics and Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Van Holsbeke
authors.affiliation: Dept. Obstetrics and Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium.
authors.forename: E T M
authors.initials: ET
authors.lastname: de Jonge
authors.affiliation: Dept. Obstetrics and Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium. ; Dept. of Physiology, Hasselt University, Diepenbeek, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Gyselaers
keywords: Birth asphyxia; metabolic acidosis; neonatal care; perinatal audit; perinatal outcome
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