Neonatal near-misses in Ghana: a prospective, observational, multi-center study.

Autor: Bakari A; Department of Child Health, Suntreso Government Hospital, Ghana Health Service, Kumasi, Ghana., Bell AJ; Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA., Oppong SA; Department of Obstetrics and Gynecology, Medical School, University of Ghana, Accra, Ghana., Bockarie Y; Department of Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana., Wobil P; Department of Child Health, Komfo Anokye Teaching Hospital / Kwame Nkrumah University of Science and Technology, Kumasi, Ghana., Plange-Rhule G; Department of Child Health, Komfo Anokye Teaching Hospital / Kwame Nkrumah University of Science and Technology, Kumasi, Ghana., Goka BQ; Department of Child Health, Medical School, University of Ghana, Accra, Ghana., Engmann CM; Departments of Pediatrics and Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA.; Maternal, Newborn Childhealth and Nutrition, PATH, Seattle, WA, USA., Adanu RM; Population, Family and Reproductive Health Department, University of Ghana School of Public Health, Accra, Ghana., Moyer CA; Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA. camoyer@umich.edu.; Departments of Learning Health Sciences and Obstetrics & Gynecology, University of Michigan Medical School, 1111 E. Catherine Street, 231 Victor Vaughan Bldg, Ann Arbor, MI, 48109, USA. camoyer@umich.edu.
Jazyk: angličtina
Zdroj: BMC pediatrics [BMC Pediatr] 2019 Dec 23; Vol. 19 (1), pp. 509. Date of Electronic Publication: 2019 Dec 23.
DOI: 10.1186/s12887-019-1883-y
Abstrakt: 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.
Databáze: MEDLINE
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