Thirty-seven percent of under-five deaths occur in the neonatal period. Identifying and correcting factors that contribute to
neonatal and maternal care are of the utmost importance. Evaluation of severe acute maternal morbidity, also known as ‘‘near
miss’’, is used to improve obstetric practice. Neonatal near miss in conjunction with neonatal mortality can be used in a similar fashion to identify deficiencies in care. No accepted definition of neonatal near miss currently exists. None of the neonatal morbidity scoring systems is applicable or appropriate for this
purpose. Organ system based criteria are objective and allow for identifying severe morbidities and identifying primary causes. This system can be of use in a variety of settings to identify health system problems and to institute remedial action where necessary.