Table 1 Neonatal Near-Miss Assessment Tool (NNMAT) Items^a

Category 1: EVIDENCE OF SEVERE/LIFE THREATENING COMPLICATIONS

Category 2: CLINICAL INTERVENTIONS SUGGESTIVE OF A NEAR-MISS

 Apgar Score < 7 at 5 min

Resuscitation (bag & mask) in the first minute

 Gestational Age < 33 weeks

Resuscitation in the NICU (after the first minute)

 Birthweight < 1800 g

Nasal CPAP

 Suspected subgaleal bleed

Cardiac massage/Chest compressions

 Major congenital abnormality requiring surgical repair (e.g. gastroschisis, hydrocephalus, duodenal artresia, congenital heart defect)

IV fluid bolus

 Axillary temperature < 35 or > 39

Any intubation during admission

 Severe jaundice requiring blood exchange

Double phototherapy

 Surgery in first week

Double blood exchange transfusion

Oxygen therapy

IV fluid 12h hours

Caffeine citrate/aminophylline therapy

Thermal protection > 4 h

Category 3: ORGAN DYSFUNCTION

Category 4: INVESTIGATIONS IN THE FIRST 7 DAYS

 Cardiovascular:

Haematocrit < 30%

  Capillary refill time > 3 s

Hemoglobin < 10gd/dl

  Persistent tachycardia > 180 bpm

White blood cells < 4000 cells/mm3

  Persistent bradycardia < 80 bpm

Serum bilirubin level > 10 x gestational age

  Cardiac arrest

Blood culture done

 Neurologic:

Blood culture positive