In this study the proportion of neonatal near miss was 23.3 % with 95% CI: (19.1% -27.7%).This finding is consistent with the finding of study in Northeastern Brazil 22% [10].
This finding is high as compared to study done in WHO multicounty survey 7.25%, Birth in Brazil survey 3.92%, study in South of Brazil 3.3%, and in Southeast Brazil 1.7% [8, 9, 13, 14]. Variation of neonatal near miss rate in WHO multicounty survey and Southeast Brazil was might be due to methodological difference and used only pragmatic criteria and also study in Birth in Brazil and study in South of Brazil was used only 4 selection items from management and pragmatic criteria.
In this study proportion of neonatal near miss is low as compared to study in Uganda 36.7%, this is might be due to methodological difference and inclusion criteria were new-borns only from mothers with sever obstetric complication[15].
In this study high proportion of neonatal near miss criteria were observed for mechanical ventilation (53.2%) , gestational age less than 37completed week (37.2 %), birth weight < 2.5kg (31%), 5 minute APGAR Score < 7 (22.3%) and use of parenteral antibiotics (25.5%).This is in line with study in a systemic review on neonatal near miss , Northeastern Brazil, Birth in Brazil survey and study in South of Brazil [2, 8, 10, 13].
Primiparous was statistically associated with neonatal near miss, increased 2 times the odds of NNM as compared to grand multiparous [AOR: 2.06, 95%CI:(1.06-3.98)]. This result is in line with studies in Northeastern Brazil and Southeast Brazil [10, 14].This might be due to the fact that primiparous were high risk for malposition, malpresentation, prolonged labour, increased induction of labour , obstructed labor/cephalo-pelvic disproportion.
Obstetric complication during current pregnancy were showed statistically significant to neonatal near miss. Premature rupture of membrane increased 3 times the odds of NNM [AOR: 3.10, 95%CI: (1.27-7.59)] as compared to their counter parts. This might be due to the fact that premature rupture of membrane is usually leads to preterm labor which is at risk for birth asphyxia, chorioaminities, neonatal sepsis, pulmonary hypoplasia and cord prolapse. Different studies revealed that premature rupture of membrane is increased significantly the risk of maternal, fetal and neonatal morbidity and mortality resulting from obstetric complications [16, 17].
Women with reduced fetal movement during pregnancy increased almost 6 times the odds of NNM [AOR: 5.95, 95%CI: (2.47-14.33)] as compared to mothers who did not perceive reduced fetal movement. This might be due to fetal compromised, utero-placental insufficiency, intrauterine growth restriction and abnormal amniotic fluid volume. Similarly different studies revealed that reduced fetal movement associated with poor prenatal outcomes those were preterm birth, perinatal birth injury, low birth weight, low APGAR score, increase rate of cesarean section, neonatal and fetal death [18, 19].
Obstetric complications during labor- delivery were strongly associated with neonatal near miss. Women with obstructed labor /cephalo-pelvic disproportion increased 4 times the odds of NNM [AOR: 4.05, 95%CI :( 1.55-10.57)] as compared to their counter parts. This might be due to obstructed labor causes fetal hypoxia due to tonic uterine contraction that interferes with the uteroplacental circulation, intracranial hemorrhage due to super moulding of the head, birth trauma and infection.
Mothers with prolonged labor increased 3 times the odds of NNM [AOR: 3.00, 95%CI :( 1.28-7.06)] as compared to mothers who were delivered within 24 hours of labor. This might be due to abnormal progress of labor leads to fetal distress, early neonatal and fetal infection, birth trauma and fetal hypoxia due to diminished uteroplacental circulation.
Detected non reassuring fetal heart rate pattern increased almost 4 times the odds of NNM [AOR:3.75, 95% CI : (1.69-8.33)] as compared to detected reassuring fetal heart rate pattern. Supporting study in Indonesia revealed that survival of newborn from mothers without sever complications was better than that of newborn from mothers with obstetric complications[20] and studies in Brazil also revealed that maternal near miss were strongly associated with prematurity, neonatal asphyxia and early respiratory discomfort [21].
This finding is supported, studies in Jimma university specialised hospital and Dessie referral hospital, shows that obstetric complication during current pregnancy and complication during labor and delivery were strongly associated with adverse birth outcomes(low birth weight ,preterm birth, low APGAR score and still birth)[22-24].
Referral linkage was significantly associated with neonatal near miss. This result is in line with study in Jimma university specialised hospital , revealed that referral of mothers with complications from other facility for delivery service was high risk for adverse pregnancy outcomes than mothers who were not referred[22].This is might be due to the fact that referral cases were from mothers who faced obstetric complications and needs timely and better intervention to avoid maternal and neonatal morbidity and mortality.