Adherence to Perinatal Asphyxia or Sepsis Management Guidelines in Low- and Middle-Income Countries.
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Clinical Guidelines
Authored By
Rahman A, Ray M, Madewell ZJ, Igunza KA, Akelo V, Onyango D, Murila F, Mwebia W, Ogbuanu IU, Ojulong J, Kowuor D, Kaluma E, Samura S, El Arifeen S, Gurley ES, Hossain MZ, Islam KM, Biswas R, Assefa N,
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Interests
Pediatric Medicine
Obstetrics & Gynecology
Infectious Disease & Vaccines
Speciality
Obstetrics & Gynecology
Pediatric Medicine
Infectious Disease & Vaccines
Book Detail
volume
8
ISSN
2574-3805
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["Rahman A, Ray M, Madewell ZJ, Igunza KA, Akelo V, Onyango D, Murila F, Mwebia W, Ogbuanu IU, Ojulong J, Kowuor D, Kaluma E, Samura S, El Arifeen S, Gurley ES, Hossain MZ, Islam KM, Biswas R, Assefa N, Teferi T, Eshetu K, Madrid L, Kotloff KL, Tapia MD, Keita AM, Xerinda E, de Assis CM, Kincardett M, Mandomado I, Varo R, Madhi SA, Dangor Z, Baba V, Velaphi S, Adam Y, Blau DM, Mutevedzi PC, Bassat Q, Whitney CG, Rees CA","Child Health and Mortality Prevention Surveillance (CHAMPS) Network","Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE","Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't","2025-05-01","JAMA network open [JAMA Netw Open] 2025 May 01; Vol. 8 (5), pp. e2510790. Date of Electronic Publication: 2025 May 01.","English","2574-3805","Asphyxia Neonatorum*\/therapy , Asphyxia Neonatorum*\/mortality , Guideline Adherence*\/statistics & numerical data , Neonatal Sepsis*\/therapy , Neonatal Sepsis*\/mortality , Sepsis*\/therapy , Sepsis*\/mortality, Humans ; Infant, Newborn ; Cross-Sectional Studies ; Male ; Female ; Developing Countries\/statistics & numerical data ; Africa South of the Sahara\/epidemiology ; Practice Guidelines as Topic ; Infant Mortality ; Infant","Humans, Infant, Newborn, Cross-Sectional Studies, Male, Female, Developing Countries statistics & numerical data, Africa South of the Sahara epidemiology, Practice Guidelines as Topic, Infant Mortality, Infant, Asphyxia Neonatorum therapy, Asphyxia Neonatorum mortality, Guideline Adherence statistics & numerical data, Neonatal Sepsis therapy, Neonatal Sepsis mortality, Sepsis therapy, Sepsis mortality","JAMA network open","8"]
Description
Importance: Most of the 2.3 million annual neonatal deaths occur in sub-Saharan Africa and South Asia, with perinatal asphyxia and neonatal sepsis being the leading causes of neonatal mortality. Most neonatal deaths are considered preventable through high-quality clinical care, which includes adherence to clinical care guidelines.<br />Objective: To assess adherence to World Health Organization clinical care guidelines for management of perinatal asphyxia and neonatal sepsis and to identify patient-level factors in adherence among neonates who died from these conditions.<br />Design, Setting, and Participants: This cross-sectional study obtained data from December 2015 through October 2023 from the Child Health and Mortality Prevention Surveillance (CHAMPS) catchment areas in 7 low- and middle-income countries in sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and South Asia (Bangladesh). Participants were neonates who were born alive and were aged 0 to 28 days at the time of death and had either perinatal asphyxia or neonatal sepsis.<br />Exposure: Medical records of neonates who died from perinatal asphyxia or neonatal sepsis determined by postmortem diagnostics.<br />Main Outcomes and Measures: The main outcome was the proportion of deceased neonates who received guideline-adherent treatments before they died. Mixed-effect multivariable logistic regression analyses were performed to identify factors associated with administration of at least bag-valve-mask (BVM) ventilation for perinatal asphyxia.<br />Results: Of the 1194 neonates (median [IQR] age at the time of death, 2 [1-6] days; 692 males [58.0%]) who died and were enrolled in CHAMPS with available clinical data, 476 (39.9%) died from perinatal asphyxia, 562 (47.0%) died from neonatal sepsis, and 156 (13.1%) from both conditions. These neonates had a median (IQR) birth weight of 2130 (1266-2988) g. For cases with perinatal asphyxia, guideline adherence ranged from 12.2% (n = 77) for adrenaline administration to 85.4% (540) for supplemental oxygen administration. Only 4.4% of neonates (28) with perinatal asphyxia received all recommended treatments. Among cases with neonatal sepsis, antibiotics were administered to 86.8% (623), although the recommended treatment was administered to only 61.0% (438). In multivariable analyses, neonates in whom clinicians accurately identified perinatal asphyxia were more likely to receive BVM ventilation than those who had received discordant antemortem and postmortem diagnoses (adjusted odds ratio, 2.00; 95% CI, 1.29-3.12).<br />Conclusions and Relevance: In this cross-sectional study, clinical care guideline adherence was suboptimal among neonates who died from perinatal asphyxia or neonatal sepsis. This finding underscores the critical need to increase adherence in regions with high rates of neonatal mortality and may inform strategies for strengthening health systems to support compliance with clinical care guidelines.
