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Adherence to Perinatal Asphyxia or Sepsis Management Guidelines in Low- and Middle-Income Countries.

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Adherence to clinical care guidelines for neonatal deaths from perinatal asphyxia and sepsis was suboptimal in low- and middle-income countries. Improving adherence is critical to reduce preventable neonatal mortality in high-burden regions.

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Area of Science:

  • Neonatal mortality
  • Global health
  • Clinical care guidelines

Background:

  • Neonatal deaths, primarily from perinatal asphyxia and sepsis, disproportionately affect sub-Saharan Africa and South Asia.
  • Most neonatal deaths are preventable with high-quality clinical care and adherence to established guidelines.

Purpose of the Study:

  • To evaluate adherence to World Health Organization (WHO) clinical care guidelines for managing perinatal asphyxia and neonatal sepsis.
  • To identify patient-level factors associated with guideline adherence among neonates who died from these conditions.

Main Methods:

  • A cross-sectional study analyzed medical records of neonates (0-28 days) who died from perinatal asphyxia or neonatal sepsis between December 2015 and October 2023.
  • Data were collected from Child Health and Mortality Prevention Surveillance (CHAMPS) sites in 7 low- and middle-income countries.
  • Mixed-effect multivariable logistic regression identified factors associated with guideline-adherent treatment, such as bag-valve-mask (BVM) ventilation.

Main Results:

  • Guideline adherence for perinatal asphyxia varied widely, from 12.2% for adrenaline to 85.4% for oxygen; only 4.4% received all recommended treatments.
  • For neonatal sepsis, antibiotics were given to 86.8%, but only 61.0% received the full recommended treatment.
  • Accurate clinical identification of perinatal asphyxia was linked to increased likelihood of receiving BVM ventilation (aOR, 2.00).

Conclusions:

  • Clinical care guideline adherence was suboptimal for neonates dying from perinatal asphyxia or neonatal sepsis in the study regions.
  • These findings highlight an urgent need to improve adherence to reduce neonatal mortality.
  • Strategies to strengthen health systems are essential to support compliance with clinical care guidelines.