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Table 1 Neonatal Near-Miss Assessment Tool (NNMAT) Itemsa

From: Neonatal near-misses in Ghana: a prospective, observational, multi-center study

Category 1: EVIDENCE OF SEVERE/LIFE THREATENING COMPLICATIONSCategory 2: CLINICAL INTERVENTIONS SUGGESTIVE OF A NEAR-MISS
 Apgar Score < 7 at 5 minResuscitation (bag & mask) in the first minute
 Gestational Age < 33 weeksResuscitation in the NICU (after the first minute)
 Birthweight < 1800 gNasal CPAP
 Suspected subgaleal bleedCardiac 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 > 39Any intubation during admission
 Severe jaundice requiring blood exchangeDouble phototherapy
 Surgery in first weekDouble blood exchange transfusion
Oxygen therapy
IV fluid 12h hours
Caffeine citrate/aminophylline therapy
Thermal protection > 4 h
Category 3: ORGAN DYSFUNCTIONCategory 4: INVESTIGATIONS IN THE FIRST 7 DAYS
 Cardiovascular:Haematocrit < 30%
  Capillary refill time > 3 sHemoglobin < 10gd/dl
  Persistent tachycardia > 180 bpmWhite blood cells < 4000 cells/mm3
  Persistent bradycardia < 80 bpmSerum bilirubin level > 10 x gestational age
  Cardiac arrestBlood culture done
 Neurologic:Blood culture positive
  Recurrent seizures
  Abnormal posturing
  Inability to suck
  Floppy
  Poor Feeding
  Weak Cry
  Respiratory:
  Tachypnea > 100 cpm
  Bradypnoea < 20 cpm
  Grunting
  Cyanosis in air
  Gasping
  Chest in drawing
  Apnea
 Renal:
  Oliguria or anuria > 24 h
  Gastrointestinal:
  Persistent vomiting
  Distended abdomen
  1. aAll assessed as yes/no/don’t know, with a yes in any category rolling up to a classification as a suspected ‘near-miss’, which was confirmed with survival to 28 days