Table 1 Characteristics of multidisciplinary NNM audits
From: Neonatal near-miss audits: a systematic review and a call to action
Author | Year | Country/ Setting | Design | Sample size (births) | NNM n (n/1000LB) | Stillbirth n (n/1000LB) | Neonatal death n (n/1000LB) | Audit period | Type of audit / intervention | NNM / stillbirth / neonatal death post audit |
|---|---|---|---|---|---|---|---|---|---|---|
DeKnif et al. [33]d | 2010 | South Africa, 1 regional hospital | Cohort (no baseline control period described) | 10,117 | 125 (12.3) | 14a (1.38) | 15 (1.48) | 2008- 2009 (24 months) | Case file review and confidential enquiry to identify avoidable factors, missed opportunities and substandard care. Obstetrics / gynaecology and paediatricians meeting weekly, one author reviewed for avoidable factors Problems classified in 3 groups: patient associated, administrative, medical and personnel associated problems | No data |
Bonnaerens et al. [18]d | 2011 | Belgium, 1 tertiary hospital | Cohort (no baseline control period described) | 2117 | 24 (11.4) | 12b (5.2) | 3 (1.4) | 2010 (12Â months) | Case notes reviewed by obstetricians and neonatologists Problems classified in 5 categories: fetal monitoring error, labour management error, instrumental vaginal delivery for fetal distress within 2Â h of second stage, non-obstetric medical complications, preterm births or accidental and unavoidable cases at term | No data |
Rana et al. [34]e | 2018 | Nepal, 1 district hospital and 14 community birthing centres | Modified time-series | 1386 | 30 (22) | 15c (10.8) | 11 (7.9) | 2015 (12Â months) | Monthly multidisciplinary meetings with case notes reviewed by consultant obstetricians and paediatricians This was part of a modified time series evaluation incorporating assessment and dissemination before, throughout and after the intervention | No data |
Author | Identified local perinatal risk factors | Targeted recommendations post audit | Change in quality of care post audit | Experience of staff involved | Experience of parents involved | Cost- effect | Facilitators and/or barriers |
|---|---|---|---|---|---|---|---|
DeKnif et al. [33]d | Yes. Incorrect management of second stage of labour. Patient refusal of medical treatment. No detection / no reaction to fetal distress. Inadequate facilities | Yes. Further training in management of labour. introduction of a checklist to promote decision making in the labour ward. Protocols for pain relief in labour in combination with counselling at the antenatal clinic about what to expect in labour | No data | No data | No data | No data | No data |
Bonnaerens et al. [18]d | Yes. Violation of fetal monitoring and management of labour guidelines. Inadequate active management of labour | Yes. Adaptation of local protocol for management of labour including focus on discussing harms and benefits with the parents | No data | No data | No data | No data | No data |
Rana et al. [34]e | Yes. Increased numbers of NNM were due to birth asphyxia, very low birthweight, neonatal sepsis | Yes. Increased availability and readiness of medicines/ equipment in the hospital. Increased awareness in the community to reduce risk factors, including home births and early age pregnancy | No data | Yes. Well received once it is based on a successful outcome, not a death. Useful to discuss clinical and managerial aspects of neonatal near-miss case management. (Measured by interviews and focus groups) | No data | US$ 800 per birthing centre | Barriers: time constraints, financial support, low adherence to audit guidelines |