Determinants of neonatal near miss in Australia: A multilevel analysis
Determinants of neonatal near miss in Australia: A multilevel analysis
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DOI：
10.1016/j.earlhumdev.2021.105343
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发表时间：
2021-03-05
影响因子：
2.5
通讯作者：
Loxton, Deborah
中科院分区：
文献类型：
--
作者：
Hassen, Tahir Ahmed;Chojenta, Catherine;Loxton, Deborah
背景：新生儿近遗漏(NNM)是一种新生儿险些存活到新生儿期的情况。有人假设，找出导致NNM发生的因素并及时采取干预措施，可以提高新生儿护理的质量。然而，在澳大利亚，证据有限。方法：将1973年至1978年澳大利亚妇女健康纵向研究(ALSWH)队列数据与州为基础的围产期数据收集(PDC)相关联，研究对象为2007年1月1日至2015年12月31日出生的3655名母亲和5526名新生儿。如果新生儿符合任何实用标准(胎龄32周，出生体重1500克，5分钟阿普加评分7分)，则被认为是一个险些错过的病例，并存活了整个新生儿期。结果：在5526例活产儿中，95例活产儿符合NNM标准，发病率为17.2/1000。在控制潜在混杂因素后，孕妇年龄31~34岁(AOR=2.57；95%CI：1.05，6.30)和35岁以上(AOR=4.03；95%CI：1.58，10.31)、剖宫产(AOR=2.24；95%CI：1.09，4.57)和妊娠期高血压(AOR=2.63；95%CI：1.21，5.71)是NM发生的危险因素。结论：将NNM评估纳入新生儿护理，对高龄妊娠妇女和妊娠并发症妇女进行早期筛查和干预，可提高新生儿护理质量，降低新生儿发病率。
Background: Neonatal Near Miss (NNM) is a situation where a newborn narrowly survived the neonatal period. It has been hypothesized that identifying factors that contribute to the occurrence of NNM and taking timely in-terventions could enhance the quality of newborn care. However, there is limited evidence in Australia. This study aimed to identify the determinants of NNM in Australia.Methods: Data from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) were linked with state-based Perinatal Data Collections (PDC) for 3655 mothers and 5526 newborns who were born between 01 January 2007 and 31 December 2015. A newborn was considered as a near miss case if presented with any of the pragmatic criteria (gestational age < 32 weeks, birth weight < 1500 g, five-minute Apgar score < 7) and survived the neonatal period. A multilevel multivariable logistic regression model was used to identify the determinants of NNM.Results: Of the total 5526 live births included in this study, 95 live births met the criteria for NNM, corresponding to an incidence of 17.2 per 1000 live births. After controlling for potential confounders, maternal age 31-34 years (AOR = 2.57; 95% CI: 1.05, 6.30) and 35 years and above (AOR = 4.03; 95% CI: 1.58, 10.31), caesarean section (AOR = 2.24; 95% CI: 1.09, 4.57), and gestational hypertension (AOR = 2.63; 95% CI: 1.21, 5.71) increased the odds of NNM. Conclusion: Inclusion of NNM evaluations into newborn care and early screening and interventions for women who become pregnant at older age and those with pregnancy complications could improve the quality of newborn care and reduce neonatal morbidity.