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Войти в исследования Adherence to Perinatal Asphyxia or Sepsis Management Guidelines in Low- and Middle-Income Countries.
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Rahman Afruna, Ray Meghna, Madewell Zachary J, Igunza Kitiezo Aggrey, Akelo Victor, Onyango Dickens, Murila Florence, Mwebia Winnie, Ogbuanu Ikechukwu Udo, Ojulong Julius, Kowuor Dickens, Kaluma Erick, Samura Solomon, El Arifeen Shams, Gurley Emily S, Hossain Mohammad Zahid, Islam Kazi Munisul, Biswas Rajib, Assefa Nega, Teferi Temesgen, Eshetu Konjit, Madrid Lola, Kotloff Karen L, Tapia Milagritos D, Keita Adama Mamby, Xerinda Elisio, de Assis Celisa Mendonça, Kincardett Milton, Mandomado Inacio, Varo Rosauro, Madhi Shabir A, Dangor Ziyaad, Baba Vuyelwa, Velaphi Sithembiso, Adam Yasmin, Blau Dianna M, Mutevedzi Portia C, Bassat Quique, Whitney Cynthia G, Rees Chris A, Child Health and Mortality Prevention Surveillance (CHAMPS) Network
Аннотация
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.
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.
EXPOSURE: Medical records of neonates who died from perinatal asphyxia or neonatal sepsis determined by postmortem diagnostics.
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.
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).
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.