Table 2

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

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


Souza et al. BMC Health Services Research 2011 11:286   doi:10.1186/1472-6963-11-286

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