Effect of fetal malposition, primiparous, and premature rupture of membrane on Neonatal Near miss mediated by grade three meconium-stained amniotic fluids and duration of the active first stage of labor: Mediation analysis

Abstract

Background In many low-income countries, including Ethiopia, neonatal mortality remains a major concern. For every newborn that dies, many more neonates survived (near-miss neonates) the first 28 days after birth from life-threatening conditions. The generation of evidence on neonatal near-miss determinants could be a critical step in reducing neonatal mortality rates. However, studies causal pathway determinants are limited in Ethiopia. This study aimed to investigate the Neonatal Near-miss determinants in public health hospitals in Amhara Regional State, northwest Ethiopia. Method A cross-sectional study was conducted on 1277 mother-newborn pairs at six hospitals between July 2021 and January 2022. A validated interviewer-administered questionnaire and a review of medical records were used to collect data. Data were entered into Epi-Info version 7.1.2 and exported to STATA version 16 in California, America for analysis. The paths from exposure variables to Neonatal Near-Miss via mediators were examined using multiple logistic regression analysis. The adjusted odds ratio (AOR) and ß-coefficients were calculated and reported with a 95% confidence interval and a p-value of 0.05. Results The proportion of neonatal near-misses was 28.6% (365/1277) (95% CI: 26–31%). Women who could not read and write (AOR = 1.67,95%CI:1.14–2.47), being primiparous (AOR = 2.48,95% CI:1.63–3.79), pregnancy-induced hypertension (AOR = 2.10,95% CI:1.49–2.95),being referred from other health facilities (AOR = 2.28,95% CI:1.88–3.29), premature rupture of membrane (AOR = 1.47,95% CI:1.09–1.98), and fetal malposition (AOR = 1.89,95% CI:1.14–3.16) were associated with Neonatal Near-miss. Grade III meconium stained amniotic fluid partially mediated the relationship between primiparous (ß = 0.517), fetal malposition (ß = 0.526), pregnant women referred from other health facilities (ß = 0.948) and Neonatal Near-Miss at P-value < 0.01. Duration of the active first stage of labour partially mediated the relationship between primiparous (ß = -0.345), fetal malposition (ß = -0.656), premature rupture of membranes (ß = -0.550) and Neonatal Near-Miss at P- value <0.01.It had also a significant indirect effect (ß = 0.581, P<0.001) on NNM with variables (primiparous, fetal malposition, and premature rupture of membranes). Conclusions The relationship between fetal malposition, primiparous, referred from other health facilities, premature rupture of membrane, and Neonatal Near miss were partially mediated by grade III meconium stained amniotic fluid and duration of the active first stage of labour. Early diagnosis of these potential danger signs and appropriate intervention could be of supreme importance in reducing NNM.

Experience and perceptions of healthcare providers on clinical management and care of near-miss infants: a qualitative content analysis

“…Neonatal Near Miss (NNM) refers to neonates with severe complications who almost died but survived immediately after birth. In Ethiopia, the prevalence of NNM has been assessed using a validated Neonatal Near-Miss Assessment Scale [ 1 – 3 ]. In the validated Neonatal Near-Miss Assessment Scale [ 1 – 3 ] NNM is defined as neonates who nearly died but survived after birth in hospitals’ labor wards or neonatal intensive care units, meeting at least one criterion of the validated Neonatal Near-Miss Assessment Scale.…”

“…In Ethiopia, the prevalence of NNM has been assessed using a validated Neonatal Near-Miss Assessment Scale [ 1 – 3 ]. In the validated Neonatal Near-Miss Assessment Scale [ 1 – 3 ] NNM is defined as neonates who nearly died but survived after birth in hospitals’ labor wards or neonatal intensive care units, meeting at least one criterion of the validated Neonatal Near-Miss Assessment Scale. There are certain medical criteria playing a significant role in Ethiopia [ 1 – 3 ] whereas determinants related to caring also have a causal or influential role in the survival of neonatal near-miss babies in clinical management and care, and these aspects have not been explored or studied yet in Ethiopia.…”

“…In the validated Neonatal Near-Miss Assessment Scale [ 1 – 3 ] NNM is defined as neonates who nearly died but survived after birth in hospitals’ labor wards or neonatal intensive care units, meeting at least one criterion of the validated Neonatal Near-Miss Assessment Scale. There are certain medical criteria playing a significant role in Ethiopia [ 1 – 3 ] whereas determinants related to caring also have a causal or influential role in the survival of neonatal near-miss babies in clinical management and care, and these aspects have not been explored or studied yet in Ethiopia. In the validated NNM Assessment Scale [ 1 – 3 ] the medical criteria include pregnancy-induced hypertension, premature rupture of membranes, referral from other health facilities, fetal malposition and prolonged active first stage of labor.…”

“…There are certain medical criteria playing a significant role in Ethiopia [ 1 – 3 ] whereas determinants related to caring also have a causal or influential role in the survival of neonatal near-miss babies in clinical management and care, and these aspects have not been explored or studied yet in Ethiopia. In the validated NNM Assessment Scale [ 1 – 3 ] the medical criteria include pregnancy-induced hypertension, premature rupture of membranes, referral from other health facilities, fetal malposition and prolonged active first stage of labor. To meet the 2030 Sustainable Development Goal (SDG) [ 4 ] Ethiopia plans to reduce neonatal mortality from 29 to 12 per 1000 live births by implementing proven and cost-effective newborn survival interventions [ 5 ].…”

“…Our research group has used the validated Neonatal Near-Miss Assessment Scale [ 1 , 2 ] as an audit and feedback system in University of Gondar, Debretabor, and Felegehiwot comprehensive specialized hospitals, as well as Debark General Hospital in the Amhara Regional State of northwest Ethiopia [ 1 – 3 ]. The relationship between fetal malposition, primiparous births, referrals from other health facilities, premature rupture of membranes, and NNM was partially mediated by grade III meconium-stained amniotic fluid and the duration of the active first stage of labor.…”