Factores Asociados a la Adherencia a las Guías de Práctica Clínica de Sepsis Neonatal en el Instituto Nacional Materno Perinatal del Perú

Abstract

Introduction: Adherence to clinical practice guidelines (CPG) improves the management of neonatal sepsis, reducing complications and mortality in newborns. Objective: To identify factors associated with adherence to CPG for neonatal sepsis at the Instituto Nacional Materno Perinatal (INMP). Material and Methods: A retrospective case-control study was conducted at the INMP, analyzing 988 neonatal sepsis hospitalizations between May and December 2021. Maternal and neonatal variables were evaluated using a mixed-effects logistic regression model to estimate adjusted prevalence ratios with 95% confidence intervals (CI95%). Results: Overall adherence to CPG was 75%, higher in early-onset sepsis (81,4%) than in late-onset sepsis (66,9%). Late-onset sepsis was associated with lower adherence (adjusted OR=1.37; CI95 %=1.05-1.78; p<0.01). Care provided by non-neonatologist pediatricians reduced adherence (adjusted OR=1.43; CI95 %=1.01-2.02; p=0.046). Mechanical ventilation increased adherence by 40% (adjusted OR=0.60; CI95 %=0.45-0.80). Conclusions: Adherence to CPG is higher in premature neonates and in cases requiring mechanical ventilation. Late-onset sepsis and care provided by non-neonatologist pediatricians reduce adherence. Strengthening training and optimizing CPG implementation are recommended to improve the quality of clinical management in critically ill neonates.