BACKGROUND For every newborn who dies within the first month, as many as eight more suffer life-threatening complications but survive (termed 'neonatal near-misses' (NNM)). However, there is no universally agreed-upon definition or assessment tool for NNM. This study sought to describe the development of the Neonatal Near-Miss Assessment Tool (NNMAT) for low-resource settings, as well as findings when implemented in Ghana. METHODS This prospective, observational study was conducted at two tertiary care hospitals in southern Ghana from April - July 2015. Newborns with evidence of complications and those admitted to the NICUs were screened for inclusion using the NNMAT. Incidence of suspected NNM at enrollment and confirmed near-miss (surviving to 28 days) was determined and compared against institutional neonatal mortality rates. Suspected NNM cases were compared with newborns not classified as a suspected near-miss, and all were followed to 28 days to determine odds of survival. Confirmed near-misses were those identified as suspected near-misses at enrollment who survived to 28 days. The main outcome measures were incidence of NNM, NNM:mortality ratio, and factors associated with NNM classification. RESULTS Out of 394 newborns with complications, 341 (86.5%) were initially classified as suspected near-misses at enrollment using the NNMAT, with 53 (13.4%) being classified as a non-near-miss. At 28-day follow-up, 68 (17%) had died, 52 (13%) were classified as a non-near-miss, and 274 were considered confirmed near-misses. Those newborns with complications who were classified as suspected near-misses using the NNMAT at enrollment had 12 times the odds of dying before 28 days than those classified as non-near-misses. While most confirmed near-misses qualified as NNM via intervention-based criteria, nearly two-thirds qualified based on two or more of the four NNMAT categories. When disaggregated, the most predictive elements of the NNMAT were gestational age < 33 weeks, neurologic dysfunction, respiratory dysfunction, and hemoglobin < 10 gd/dl. The ratio of near-misses to deaths was 0.55: 1, yet this varied across the study sites. CONCLUSIONS This research suggests that the NNMAT is an effective tool for assessing neonatal near-misses in low-resource settings. We believe this approach has significant systems-level, continuous quality improvement, clinical and policy-level implications.

中文翻译：

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加纳的新生儿未遂事件：一项前瞻性，观察性，多中心研究。

背景技术对于每个在出生后一个月内死亡的新生儿，多达八分之二遭受危及生命的并发症但仍存活下来（称为“新生儿近遗症”（NNM））。但是，没有针对NNM的公认的定义或评估工具。这项研究旨在描述针对资源匮乏地区的新生儿近距失误评估工具（NNMAT）的开发，以及在加纳实施时的发现。方法该前瞻性观察研究于2015年4月至7月在加纳南部的两家三级护理医院进行。使用NNMAT对有并发症迹象的新生儿和重症监护病房（NICU）进行筛查。确定入组时疑似NNM的发生率，并确认未命中（存活至28天），并将其与机构新生儿死亡率进行比较。将怀疑的NNM病例与未归类为疑似未遂的新生儿进行比较，所有病例均随访28天以确定存活几率。经确认的未遂事件是在入学时被确认为存活至28天的可疑未遂事件。主要结局指标是NNM的发生率，NNM：死亡率和与NNM分类相关的因素。结果在394例有并发症的新生儿中，最初使用NNMAT将341例（86.5％）归类为可疑的近遗症，其中53例（13.4％）被归类为非遗失。在28天的随访中，有68名（17％）死亡，52名（13％）被归类为未失踪人员，其中274人被确认为未遂。入组时使用NNMAT分类为疑似未遂的并发症新生儿，其在28天前死亡的几率是未归类为未遗漏的新生儿的12倍。通过基于干预的标准，大多数被确认的未击中合格者均属于NNM，而基于四个NNMAT类别中的两个或多个，则有近三分之二合格。分解时，NNMAT最可预测的要素是胎龄<33周，神经系统功能障碍，呼吸功能障碍和血红蛋白<10 gd / dl。未命中与死亡的比率为0.55：1，但这在研究地点之间有所不同。结论这项研究表明NNMAT是评估低资源环境下新生儿未遂事件的有效工具。我们认为，这种方法可在系统级，持续的质量改进方面取得显著成效，