SciELO - Scientific Electronic Library Online

 
vol.51Factors associated with frailty in a community-dwelling population of older adultsInequality of opportunity in health: evidence from Chile author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Revista de Saúde Pública

On-line version ISSN 1518-8787

Abstract

KALE, Pauline Lorena et al. Pragmatic criteria of the definition of neonatal near miss: a comparative study. Rev. Saúde Pública [online]. 2017, vol.51, 111.  Epub Dec 04, 2017. ISSN 1518-8787.  https://doi.org/10.11606/s1518-8787.2017051006587.

OBJECTIVE

The objective of this study was to test the validity of the pragmatic criteria of the definitions of neonatal near miss, extending them throughout the infant period, and to estimate the indicators of perinatal care in public maternity hospitals.

METHODS

A cohort of live births from six maternity hospitals in the municipalities of São Paulo, Niterói, and Rio de Janeiro, Brazil, was carried out in 2011. We carried out interviews and checked prenatal cards and medical records. We compared the pragmatic criteria (birth weight, gestational age, and 5’ Apgar score) of the definitions of near miss of Pileggi et al., Pileggi-Castro et al., Souza et al., and Silva et al. We calculated sensitivity, specificity (gold standard: infant mortality), percentage of deaths among newborns with life-threatening conditions, and rates of near miss, mortality, and severe outcomes per 1,000 live births.

RESULTS

A total 7,315 newborns were analyzed (completeness of information > 99%). The sensitivity of the definition of Pileggi-Castro et al. was higher, resulting in a higher number of cases of near miss, Souza et al. presented lower value, and Pileggi et al. and de Silva et al. presented intermediate values. There is an increase in sensitivity when the period goes from 0–6 to 0–27 days, and there is a decrease when it goes to 0–364 days. Specificities were high (≥ 97%) and above sensitivities (54% to 77%). One maternity hospital in São Paulo and one in Niterói presented, respectively, the lowest and highest rates of infant mortality, near miss, and frequency of births with life-threatening conditions, regardless of the definition.

CONCLUSIONS

The definitions of near miss based exclusively on pragmatic criteria are valid and can be used for monitoring purposes. Based on the perinatal literature, the cutoff points adopted by Silva et al. were more appropriate. Periodic studies could apply a more complete definition, incorporating clinical, laboratory, and management criteria, including congenital anomalies predictive of infant mortality.

Keywords : Near miss, classification; Infant Mortality; Birth Wieght; Infant; Premature Apgar score.

        · abstract in Portuguese     · text in English | Portuguese     · English ( pdf ) | Portuguese ( pdf )