Neonatal near miss review: Tracking its conceptual evolution and wayforward.

Background: Near miss concept is a potentially useful approach to assess quality of newborn care. Analogous to MNM (Maternal near miss) approach which is already established, NNM (Neonatal Near Miss) is an evolving concept and so far, there are no standard criteria or definition for NNM. However, it may be referred to newborns that nearly died between 0-28 days but survived by chance or because of good quality of care. Objective: To conceptualize NNM event based on the experience on MNM; to review the NNM studies conducted so far and to understand the similarities, differences and gaps in these studies which will provide suggestions for conduction of future studies. Methods: We searched the Cochrane library, Google, PubMed, MEDLINE and EMBASE databases, and reference lists of published studies from 1998 till date. Results: The NNM rate in different studies done so far varies from 21-72%, mainly because of discrepancy in the criteria used. Most of the work is retrospective and some studies have evaluated neonatal near miss cases only in specific conditions like obstetric complications and specific settings like health facilities at lower level. Conclusion: The conceptual framework to understand NNM can be well adapted from MNM for designing future studies. Future studies should also have a prospective study design; consider important points such as simpler neonatal morbidity scoring systems and include some additional management variables and congenital malformations. Consensus on definition and simple, feasible and meaningful criteria for identification of NNM cases is the need of the hour.