Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;63(3):352-359.
doi: 10.1111/ajo.13634. Epub 2022 Nov 29.

Current approach and attitudes toward neonatal near-miss and perinatal audits: An exploratory international survey

Poliana de Barros Medeiros  1   2 , Helen Liley  3   4 , Christine Andrews  1 , Adrienne Gordon  1   5 , Alexander E P Heazell  6   7   8 , Alison L Kent  9   10 , Susannah H Leisher  1   8 , Vicki Flenady  1   8
Affiliations

Current approach and attitudes toward neonatal near-miss and perinatal audits: An exploratory international survey

Poliana de Barros Medeiros et al. Aust N Z J Obstet Gynaecol. 2023 Jun.

Abstract

Background: Combined with perinatal mortality review, neonatal near-miss (NNM) audit has the potential to inform strategies to better prevent adverse perinatal outcomes. Nonetheless, there is lack of standardised definitions of NNM and limited evidence of implementation of NNM audits.

Aim: To describe definitions of NNM and assess current approaches and attitudes toward perinatal mortality and morbidity audit.

Materials and methods: Online survey from December 2021 to February 2022, with a mix of Likert scales, polar, pool, multi-choice, and open-ended questions, disseminated through national and international organisations to perinatal healthcare workers from high-income countries.

Results: One hundred and twenty participants came from Australia (n = 86), New Zealand (n = 18), Canada (n = 7), USA (n = 4), Netherlands (n = 2), other countries (n = 3). Neonatologists (35%), midwives (21.7%), obstetricians (12.5%), neonatal nurse practitioners (11.7%) and others (23.3%) responded. Most respondents thought the main characteristics to define NNM were birth asphyxia needing therapeutic hypothermia (68.3%), unexpected resuscitation at birth (67.5%), need for intubation/chest compression/adrenaline (65.0%) and metabolic acidosis at birth (60.0%). There were 97.5% of participants who considered NNM important for identifying cases for perinatal morbidity audits. However, only 10.0% of their institutions used a NNM definition. Overall, 98.4% of participants considered perinatal mortality and morbidity audits important to prevent adverse outcomes.

Conclusion: Neonatal near-miss audit is viewed as a valuable tool to reduce adverse neonatal outcomes. There was reasonable consensus that NNM encompassed evidence of birth asphyxia and/or advanced neonatal resuscitation. Data from this international survey identifies a starting point for a consensus definition of NNM, which can be used for perinatal audits to identify opportunities for improvement.

Keywords: audit; high-income country; neonatal near-miss; perinatal death; perinatal morbidity.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Most important characteristics to define a neonatal near‐miss (NNM) case according to participants. Percentage of participants who considered the characteristic important. Characteristics were selected from a list of multi‐choice options (select all that apply), with an option to write a free‐text response as well.
Figure 2
Figure 2
Main causes of a neonatal near‐miss (NNM) case according to participants. Percentage of participants who considered items as an important cause of NNM, from a list of multi‐choice options (select all that apply), with an option to write a free‐text response as well.
See this image and copyright information in PMC

References

    1. Flenady V, Wojcieszek AM, Middleton P et al. Stillbirths: Recall to action in high‐income countries. Lancet 2016; 387(10019): 691–702. - PubMed
    1. Frøen JFD, Friberg IKP, Lawn JEP et al. Stillbirths: progress and unfinished business. Lancet 2016; 387(10018): 574–586. - PubMed
    1. WHO . Making every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths. Geneva, Switzarland. 2016. https://apps.who.int/iris/handle/10665/249523.
    1. Drife JO. Perinatal audit in low‐ and high‐income countries. Semin Fetal Neonatal Med 2006; 11(1): 29–36. - PubMed
    1. Royal College of Obstetricians and Gynaecologists . Each Baby Counts: 2019 Progress Report. London: RCOG, 2020.