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Table 2 Conditions to be tested as criteria for identifying neonatal near-miss cases.

From: The world health organization multicountry survey on maternal and newborn health: study protocol

 

Identification criteria

Clinical organ dysfunction

• Respiratory rate > 100 breaths per minute

 

• Cyanosis in room air

 

• Absence of regular breathing pattern (gasping respiration or frequent apnoea)

 

• Cardiac arrest

 

• Persistent bradycardia < 80 bpm

 

• Persistent tachycardia > 200 bpm

 

• Poor capillary filling (> 5s)

 

• Subaponeurotic haemorrhage

 

• Seizures

 

• Severe neurological depression (inability to suck)

 

• Severe pallor

 

• Visible jaundice in first 24 hours

 

• Any active, non traumatic, bleeding (e.g. GI bleeding, pulmonary haemorrhage)

 

• Visible haematuria

 

• Anuria > 24 hours

 

• Apathetic/Poor tolerance of feeds

 

• Abdominal distension and vomiting

 

• Brachial plexus injury

 

• Skull fracture

Laboratory markers of organ dysfunction

• Saturation by pulse oximetry < 85% in room air

 

• pCO2 > 65 mmHg

 

• Serum pH < 7.1

 

• Haematocrit < 30%

 

• Haemoglobin < 10 g/dl

 

• Glucose < 30 mg/dl or < 1.7 mmol/l

 

• White cell count < 4000 cells/mm3

 

• Neutropaenia < 1000 cells/mm3

 

• Raised C-Reactive Protein within 48 hours > 10 mg/dlx.

 

• X-ray signs of intestinal obstruction/perforation

 

• X-ray signs of skull fracture

Management indicators of severity

• Any intubation (at birth or anytime within first week)

 

• Nasal CPAP

 

• Ventilation

 

• Surfactant administration

 

• Cardio-pulmonary resuscitation (cardiac massage)

 

• Use of any vasoactive drug

 

• Volume expansion

 

• Use of anticonvulsants

 

• Use of phototherapy in the first 24 hours

 

• Exchange transfusion

 

• Use of any blood products

 

• Use of steroids to treat refractory hypoglycaemia

 

• Use of therapeutic IV antibiotics

 

• Any surgery requiring general anaesthesia

Other conditions highly associated with severity in perinatal health

• Birth weight < 1500 g

 

• Gestational age at birth < 31 weeks

 

• Apgar score 5 minutes < 5