Analysis of Maternal Factors Impacting Neonatal Near Miss (NNM) Events: A Tertiary Centre Experience.

Objective: To find out the incidence of neonatal near miss (NNM) cases in comparison with the neonatal deaths and to study the different antenatal and intrapartum maternal variables and system-related delays influencing these events. Methodology: This is a descriptive retrospective study conducted over a year (2018-2019) at a tertiary referral hospital in India, where NNM cases were selected as per 'pragmatic criteria', and detailed maternal and neonatal biological variables and near miss indicators were procured from the medical record books and analysed. Results: Out of 6383 live births and 231 neonatal deaths in the hospital during the study period, 810 NNM cases were identified born to 710 mothers, i.e. 3.5 cases for each neonatal death. Birth weight and gestational age in combination contributed to the maximum number of cases-383 (47.28%). The most common reason for referral was threatened pre-term/PPROM with non-availability of NICU-197 cases (38.3%) out of 514 referrals. Out of 710 mothers, 529 (74.5%) had at least one comorbidity at the time of presentation. The most common comorbidity was anaemia in 267 women followed by hypertensive disorder of pregnancy-in 251 cases. Primary delay contributed to 54% of all delays in the study. Conclusion: NNM can be used as an effective tool for quality control and audits to effectively reduce maternal and neonatal morbidity and mortality but needs more research to establish a standardized definition and criteria for selection of cases.