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Wainaina J, Ogero M, Mumelo L, Wairoto K, Mbevi G, Tuti T, Mwaniki P, Irimu G, English M, Aluvaala J. Hypothermia amongst neonatal admissions in Kenya: a retrospective cohort study assessing prevalence, trends, associated factors, and its relationship with all-cause neonatal mortality. Front Pediatr 2024; 12:1272104. [PMID: 38601273 PMCID: PMC11004247 DOI: 10.3389/fped.2024.1272104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/26/2024] [Indexed: 04/12/2024] Open
Abstract
Background Reports on hypothermia from high-burden countries like Kenya amongst sick newborns often include few centers or relatively small sample sizes. Objectives This study endeavored to describe: (i) the burden of hypothermia on admission across 21 newborn units in Kenya, (ii) any trend in prevalence of hypothermia over time, (iii) factors associated with hypothermia at admission, and (iv) hypothermia's association with inpatient neonatal mortality. Methods A retrospective cohort study was conducted from January 2020 to March 2023, focusing on small and sick newborns admitted in 21 NBUs. The primary and secondary outcome measures were the prevalence of hypothermia at admission and mortality during the index admission, respectively. An ordinal logistic regression model was used to estimate the relationship between selected factors and the outcomes cold stress (36.0°C-36.4°C) and hypothermia (<36.0°C). Factors associated with neonatal mortality, including hypothermia defined as body temperature below 36.0°C, were also explored using logistic regression. Results A total of 58,804 newborns from newborn units in 21 study hospitals were included in the analysis. Out of these, 47,999 (82%) had their admission temperature recorded and 8,391 (17.5%) had hypothermia. Hypothermia prevalence decreased over the study period while admission temperature documentation increased. Significant associations were found between low birthweight and very low (0-3) APGAR scores with hypothermia at admission. Odds of hypothermia reduced as ambient temperature and month of participation in the Clinical Information Network (a collaborative learning health platform for healthcare improvement) increased. Hypothermia at admission was associated with 35% (OR 1.35, 95% CI 1.22, 1.50) increase in odds of neonatal inpatient death. Conclusions A substantial proportion of newborns are admitted with hypothermia, indicating a breakdown in warm chain protocols after birth and intra-hospital transport that increases odds of mortality. Urgent implementation of rigorous warm chain protocols, particularly for low-birth-weight babies, is crucial to protect these vulnerable newborns from the detrimental effects of hypothermia.
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Affiliation(s)
- John Wainaina
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Morris Ogero
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Livingstone Mumelo
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Kefa Wairoto
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - George Mbevi
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Timothy Tuti
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Paul Mwaniki
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Grace Irimu
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Oxford, United Kingdom
| | - Jalemba Aluvaala
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Shi Q, Zhang J, Fan C, Zhang A, Zhu Z, Tian Y. Factors influencing hypothermia in very low/extremely low birth weight infants: a meta-analysis. PeerJ 2023; 11:e14907. [PMID: 36846465 PMCID: PMC9948743 DOI: 10.7717/peerj.14907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/25/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Previous studies have explored factors that influence the occurrence of hypothermia in very low/extremely low birth weight (VLBW/ELBW) infants, but the factors associated with hypothermia in VLBW or ELBW infants remain inadequately evaluated due to limited prospective data and inconsistency in study populations. Therefore, it is necessary to systematically evaluate the risk factors of hypothermia in VLBW/ELBW infants in order to provide a theoretical basis for clinical practice. Methods PubMed and other databases were used to search for case-control or cohort studies on factors influencing the occurrence of hypothermia in VLBW/ELBW infants. The search time was set from database creation to June 30th, 2022. Literature screening, quality evaluation, and data extraction were performed independently by two investigators according to predefined inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.3. Results A total of 10 papers were finally included in this study and 12 factors were established by meta-analysis: body weight (six papers), failure to keep warm in time (three papers), neonatal resuscitation (seven papers), gestational age (three papers), premature rupture of membranes (three papers), maternal combined complications (four papers), cesarean section (six papers), antenatal steroids (four papers), multiple birth (two papers), small for gestational age (two papers), 1 min Apgar score (three papers), and 5 min Apgar score (three papers). Since only one study included race, age (hour), socio-economic status, and spontaneous labor, these factors could not be fitted into RevMan 5.3 for the analysis. Conclusion Although there were differences in the study design of the included literature, the influencing factors described in each study were relatively similar. The influencing factors identified in this study may contribute to the construction of related intervention strategies for hypothermia in VLBW/ELBW infants.
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Affiliation(s)
- Qinchuan Shi
- Pediatric Surgery, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, PR China
| | - Jingjing Zhang
- Obstetrics, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, PR China
| | - Chong Fan
- Emergency Medicine, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, PR China
| | - Aixia Zhang
- Nursing, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, PR China
| | - Zhu Zhu
- Nursing, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, PR China
| | - Yingying Tian
- Special Section, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, PR China
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Kyokan M, Bochaton N, Jirapaet V, Pfister RE. Early detection of cold stress to prevent hypothermia: A narrative review. SAGE Open Med 2023; 11:20503121231172866. [PMID: 37197020 PMCID: PMC10184202 DOI: 10.1177/20503121231172866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
Temperature monitoring is essential for assessing neonates and providing appropriate neonatal thermal care. Thermoneutrality is defined as the environmental temperature range within which the oxygen and metabolic consumptions are minimum to maintain normal body temperature. When neonates are in an environment below thermoneutral temperature, they respond by vasoconstriction to minimise heat losses, followed by a rise in metabolic rate to increase heat production. This condition, physiologically termed cold stress, usually occurs before hypothermia. In addition to standard axillary or rectal temperature monitoring by a thermometer, cold stress can be detected by monitoring peripheral hand or foot temperature, even by hand-touch. However, this simple method remains undervalued and generally recommended only as a second and lesser choice in clinical practice. This review presents the concepts of thermoneutrality and cold stress and highlights the importance of early detection of cold stress before hypothermia occurs. The authors suggest systematic clinical determination of hand and foot temperatures by hand-touch for early detection of physiological cold stress, in addition to monitoring core temperature for detection of established hypothermia, particularly in low-resource settings.
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Affiliation(s)
- Michiko Kyokan
- Institute of Global Health, University of Geneva, Geneve, Switzerland
- Michiko Kyokan, Institute of Global Health, University of Geneva, 24 rue du Général-Dufour, Genève 1211, Switzerland.
| | - Nathalie Bochaton
- Geneva University Hospitals and Geneva University, Geneve, Switzerland
| | - Veena Jirapaet
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
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Wako WG, Beyene BN, Wayessa ZJ, Fikrie A, Amaje E. Assessment of neonatal thermal cares: Practices and beliefs among rural women in West Guji Zone, South Ethiopia: A cross-sectional study. PLOS Glob Public Health 2022; 2:e0000568. [PMID: 36962360 PMCID: PMC10021890 DOI: 10.1371/journal.pgph.0000568] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 05/11/2022] [Indexed: 11/18/2022]
Abstract
A newborn has a limited capacity to maintain temperature when exposed to cold environment. Neonatal hypothermia, a common neonatal problem, carries high case fatality rate particularly if concurrently occurs with other neonatal problems. This study assessed neonatal thermal care practices and beliefs among rural women in west Guji Zone, south Ethiopia. A community based cross sectional quantitative study combined with qualitative study was undertaken in rural areas of west Guji Zone, Ethiopia. Randomly selected 388 rural mothers of infants less than 6 months old were participated in the quantitative study. Three focus group discussions were conducted among mothers of infants less than 6 months old. Quantitative data were collected by using structured and pretested Afaan Oromo version questionnaire adapted from relevant literatures. Qualitative data were collected by focus group discussion guide. The quantitative data were cleaned, coded and analyzed by SPSS version 20. Qualitative data were transcribed, translated, coded, and analyzed by thematic analysis approach. In general rural women believe that thermal protection of newborn is important. The findings show that approximately 75% and 85% of newborns were dried and wrapped respectively after delivery. However drying and wrapping of newborn are usually done after the first newborn's bath. Just over 84% of newborns were bathed within the first 6 hours of delivery and majority of them were bathed with warm water. About 69.1% and 57.7% of women put head cover to their newborns immediately after birth, and initiated breast feeding within one hour of delivery respectively. Skin to skin care of newborn is non-existent in the study area and perceived as an odd, frightening and potentially dangerous practice. Studied women practice some of the recommended neonatal thermal cares and believe in their importance in keeping newborn warm. However, practice and beliefs about delayed first bath is against standard recommendation, whereas skin to skin care is non-existent and perceived as an odd practice. Interventions to familiarize skin to skin care and reduce misconceptions surrounding it should be introduced into the study area to improve thermal cares of high risk newborns.
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Affiliation(s)
- Wako Golicha Wako
- Bule Hora University, Institute of Health, School of Public Health, Bule Hora, Ethiopia
| | - Belda Negesa Beyene
- Department of Midwifery, Bule Hora University, Institute of Health, Bule Hora, Ethiopia
| | | | - Aneteneh Fikrie
- Bule Hora University, Institute of Health, School of Public Health, Bule Hora, Ethiopia
| | - Elias Amaje
- Bule Hora University, Institute of Health, School of Public Health, Bule Hora, Ethiopia
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Patel M, Ramagaga N, Kruger D, Lehnerdt G, Mansoor I, Mohlala L, Rendel D, Zaheed F, Jordaan M, Mokhachane M, Nakwa FL, Mphahlele R. Hypothermia in neonates born by caesarean section at a tertiary hospital in South Africa. Front Pediatr 2022; 10:957298. [PMID: 36561484 PMCID: PMC9763723 DOI: 10.3389/fped.2022.957298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION neonatal hypothermia has previously been noted in a large proportion of neonates born through Caesarean section at Chris Hani Baragwanath Hospital (CHBAH), yet no study in South Africa specifically explores the extent and severity of the threat of hypothermia to this population of neonates. OBJECTIVES to describe the proportion and severity of neonatal hypothermia in infants born via Caesarean section at CHBAH as well as to document and describe possible contributing factors to neonatal hypothermia in this population. METHODS A neonatal unit's database records were reviewed for demographic information of patients and their mothers, clinical characteristics, body temperature and outcomes. Comparisons between normothermic and hypothermic neonates were performed. RESULTS Forty-one percent of neonates born via Caesarean section had hypothermia at birth, of whom 71%, 27% and 2% had mild, moderate and severe hypothermia, respectively. Prevalence of admission hypothermia was 42%. On average, neonates were born at term and were of normal birth weight. No maternal factors were found to be statistically significant. Bag-mask ventilation (BMV) and cardiopulmonary resuscitation (CPR) [3.4% vs. 0.7%, p-0.033; OR 2.67 (95% CI: 1.06-6.77)] and an elevated lactate [13.25 vs. 3.2 mmol/l, p-0.032; OR 1.13 (95% CI: 1.01-1.26)] were associated with hypothermia. In the multivariable logistic regression analysis hypothermia in neonates was associated with an elevated lactate. CONCLUSIONS Prevalence of hypothermia in neonates born by Caesarean section is high and further prospective studies are required to elucidate the factors contributing to this.
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Affiliation(s)
- Mariambibi Patel
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Neo Ramagaga
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Danielle Kruger
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Grace Lehnerdt
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Imraan Mansoor
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Lesedi Mohlala
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Dylan Rendel
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Fathima Zaheed
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Mimie Jordaan
- District Clinical Specialist Team, Johannesburg Health District, Johannesburg, South Africa
| | - Mantoa Mokhachane
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Firdose Lambey Nakwa
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ramatsimele Mphahlele
- District Clinical Specialist Team, Johannesburg Health District, Johannesburg, South Africa
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Asmare Techane M, Asmare Atalell K, Wondim A. Neonatal hypothermia and its association with delayed initiation of breastfeeding and low birth weight in Ethiopia: Systematic review and meta-analysis. International Journal of Africa Nursing Sciences 2022. [DOI: 10.1016/j.ijans.2022.100428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Nyandiko WM, Kiptoon P, Lubuya FA. Neonatal hypothermia and adherence to World Health Organisation thermal care guidelines among newborns at Moi Teaching and Referral Hospital, Kenya. PLoS One 2021; 16:e0248838. [PMID: 33755686 PMCID: PMC7987163 DOI: 10.1371/journal.pone.0248838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 03/05/2021] [Indexed: 12/02/2022] Open
Abstract
Neonatal hypothermia is a great concern with near epidemic levels globally. In Kenya, its prevalence is as high as 87% with limited local data on the associated factors such as adherence to warm chain guidelines as recommended by the World Health Organisation (WHO) is limited. This study aimed to determine the prevalence of hypothermia and level of adherence to the WHO thermal care guidelines among newborns admitted at Moi Teaching and Referral Hospital (MTRH). It adopted a prospective study design of following up neonates for the first 24 hours of admission to the MTRH newborn unit. Thermometry, interview of mothers and observation of thermal care practices was done. Descriptive and inferential statistical techniques were adopted. Specifically, Pearson’s chi-square test of associations between predictors of neonatal hypothermia and management outcomes was conducted with their corresponding risk estimates at 95% confidence interval. Among the 372 participants, 64.5% (n = 240) were born at MTRH, 47.6% (177) were preterm and 53.2% (198) had birth weights below 2500 grams. Admission hypothermia was noted among 73.7% (274) and 13% (49) died on the first day of admission. Only 7.8% (29) newborns accessed optimal thermal care. Prematurity, day one mortality and adherence to the warm chain were significantly (p<0.001) associated with admission hypothermia. Inappropriate thermal appliance, inadequate clothing and late breastfeeding significantly increased the risk of neonatal hypothermia. Absence of admission hypothermia increased the likelihood of neonatal survival more than twenty-fold (AOR = 20.91, 95% CI: 2.15–153.62). Three out four neonates enrolled had admission hypothermia which was significantly associated with prematurity, lack of adherence to warm chain and increased risk of neonatal mortality on the first day of life. There was low adherence to the WHO thermal care guidelines. This should be optimized among preterm neonates to improve likelihood of survival.
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Affiliation(s)
- Winstone Mokaya Nyandiko
- Department of Child Health and Paediatrics, Moi University College of Health Science, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Paul Kiptoon
- Department of Child Health and Paediatrics, Moi University College of Health Science, Eldoret, Kenya
| | - Florence Ajaya Lubuya
- Department of Child Health and Paediatrics, Moi University College of Health Science, Eldoret, Kenya
- * E-mail:
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Seifu B, Belema D, Mamo K, Bulto GA. Determinants of Neonatal Hypothermia Among Babies Born in Public Hospitals of West Shewa Zone of Oromia Regional State, Ethiopia: Unmatched Case–Control Study. RRN 2021. [DOI: 10.2147/rrn.s293123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Danladi J, Sabir H. Perinatal Infection: A Major Contributor to Efficacy of Cooling in Newborns Following Birth Asphyxia. Int J Mol Sci 2021; 22:ijms22020707. [PMID: 33445791 PMCID: PMC7828225 DOI: 10.3390/ijms22020707] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 12/19/2022] Open
Abstract
Neonatal encephalopathy (NE) is a global burden, as more than 90% of NE occurs in low- and middle-income countries (LMICs). Perinatal infection seems to limit the neuroprotective efficacy of therapeutic hypothermia. Efforts made to use therapeutic hypothermia in LMICs treating NE has led to increased neonatal mortality rates. The heat shock and cold shock protein responses are essential for survival against a wide range of stressors during which organisms raise their core body temperature and temporarily subject themselves to thermal and cold stress in the face of infection. The characteristic increase and decrease in core body temperature activates and utilizes elements of the heat shock and cold shock response pathways to modify cytokine and chemokine gene expression, cellular signaling, and immune cell mobilization to sites of inflammation, infection, and injury. Hypothermia stimulates microglia to secret cold-inducible RNA-binding protein (CIRP), which triggers NF-κB, controlling multiple inflammatory pathways, including nod-like receptor family pyrin domain containing 3 (NLRP3) inflammasomes and cyclooxygenase-2 (COX-2) signaling. Brain responses through changes in heat shock protein and cold shock protein transcription and gene-expression following fever range and hyperthermia may be new promising potential therapeutic targets.
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Affiliation(s)
- Jibrin Danladi
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital University of Bonn, 53127 Bonn, Germany;
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Correspondence:
| | - Hemmen Sabir
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital University of Bonn, 53127 Bonn, Germany;
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
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Girma B, Tolessa BE, Bekuma TT, Feyisa BR. Hypothermia on admission to a neonatal intensive care unit in Oromia, western Ethiopia: a case-control study. BMJ Paediatr Open 2021; 5:e001168. [PMID: 34734127 PMCID: PMC8522663 DOI: 10.1136/bmjpo-2021-001168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Hypothermia is believed to affect more than half of Ethiopian neonates. The goal of this study is to determine risk factors for newborn hypothermia in neonates admitted to public hospitals in the east Wollega zone of western Ethiopia's neonatal intensive care unit. DESIGN Unmatched case-control study using neonates admitted to the intensive care unit. SETTING Neonatal intensive care units at public hospitals in western Ethiopia. PATIENTS Neonates admitted to intensive care units. MAIN OUTCOMES The cases were all neonates with hypothermia (less than 36.5°C) and the controls were all neonates with a body temperature of greater or equal to 36.5°C when admitted to the neonatal intensive care unit for other reasons. RESULTS The study involved the participation of 73 cases and 146 controls. The study found that delayed breastfeeding initiation after 1 hour (adjusted OR (AOR)=3.72; 95% CI: 1.39 to 10.00), admission weight less than 2500 g (AOR=3.43; 95% CI: 1.18 to 9.97), cardiopulmonary resuscitation at birth (AOR=3.42; 95% CI: 1.16 to 10.10.08), lack of immediate skin-to-skin contact with their mother (AOR=4.54; 95% CI: 1.75 to 11.81), night-time delivery (AOR=6.63; 95% CI: 2.23 to 19.77) and not wearing a cap (AOR=2.98; 95% CI: 1.09 to 8.15) were all associated with newborn hypothermia. CONCLUSIONS Neonatal hypothermia was associated with obstetric, neonatal and healthcare provider factors. As a result, special consideration should be given to the thermal care of low birthweight neonates and the implementation of warm-chain principles with low-cost thermal protection in Ethiopian public health facilities.
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Affiliation(s)
- Bikila Girma
- Department of Public Health, Wollega University, Nekemte, Ethiopia
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Cavallin F, Calgaro S, Brugnolaro V, Wingi OM, Muhelo AR, Da Dalt L, Pizzol D, Putoto G, Trevisanuto D. Non-linear association between admission temperature and neonatal mortality in a low-resource setting. Sci Rep 2020; 10:20800. [PMID: 33247153 PMCID: PMC7695844 DOI: 10.1038/s41598-020-77778-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 11/13/2020] [Indexed: 11/09/2022] Open
Abstract
Both neonatal hypothermia and hyperthermia represent important risk factors for neonatal mortality, but information on mortality risk across a full range of neonatal temperatures is lacking in low-resource settings. We evaluated the association between neonatal mortality and a full range of admission temperatures in a low-resource setting. This retrospective observational study was conducted at Beira Central Hospital, Mozambique. The relationship between admission temperature and mortality was evaluated using multivariable analyses with temperature modeled as non-linear term. Among 2098 neonates admitted to the Special Care Unit between January–December 2017, admission temperature was available in 1344 neonates (64%) who were included in the analysis. A non-linear association between mortality rate and temperature was identified. Mortality rate decreased from 84% at 32 °C to 64% at 34.6 °C (− 8% per °C), to 41% at 36 °C (− 16% per °C), to 26% to 36.6 °C (− 25% per °C) and to 22% at 38.3 °C (− 2% per °C), then increased to 40% at 41 °C (+ 7% per °C). Mortality rate was estimated to be at minimum at admission temperature of 37.5 °C. In conclusions, the non-linear relationship highlighted different mortality risks across a full range of neonatal temperatures in a low-resource setting. Admission temperature was not recorded in one third of neonates.
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Affiliation(s)
| | - Serena Calgaro
- Doctors With Africa CUAMM, Padua, Italy.,Department of Woman's and Child's Health, University of Padova, Via Giustiniani, 3, 35128, Padua, Italy
| | - Valentina Brugnolaro
- Department of Woman's and Child's Health, University of Padova, Via Giustiniani, 3, 35128, Padua, Italy
| | | | | | - Liviana Da Dalt
- Department of Woman's and Child's Health, University of Padova, Via Giustiniani, 3, 35128, Padua, Italy
| | | | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Via Giustiniani, 3, 35128, Padua, Italy.
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Yitayew YA, Aitaye EB, Lechissa HW, Gebeyehu LO. Neonatal Hypothermia and Associated Factors among Newborns Admitted in the Neonatal Intensive Care Unit of Dessie Referral Hospital, Amhara Region, Northeast Ethiopia. Int J Pediatr 2020; 2020:3013427. [PMID: 33014077 DOI: 10.1155/2020/3013427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 08/18/2020] [Accepted: 08/26/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Neonatal hypothermia is the reduction in the body temperature of the newborn (less than 36.5°C). It is a global problem in neonates born both at hospitals and homes, but it showed a higher prevalence in developing countries (>90%). Although hypothermia is rarely a direct cause of death, it contributes to a substantial proportion of neonatal mortality globally. Objective To assess neonatal hypothermia and associated factors among newborns admitted in the NICU of Dessie Referral Hospital. Methods and Materials An institution-based cross-sectional study was conducted from March 15 to May 30, 2018. The data was collected from the mother and the chart of the newborn using a semistructured questionnaire. Data were cleaned, coded, and entered in EPI-info version 7.1.2.0 then exported to Statistical Package for Social Sciences (SPSS) version 20 software for analysis. Descriptive statistics were used to summarize the data. Bivariate and multivariate logistic regression and crude and adjusted odds ratio with their 95% confidence interval were computed. Finally, p value < 0.05 was used to identify variables that had a significant association with neonatal hypothermia. Result The proportion of neonatal hypothermia in the study area was 66.8%. Preterm delivery (AOR = 2.6, 95% CI: 1.1, 6.2), no skin-to-skin contact within 1 hour of delivery (AOR = 3.0, 95% CI: 1.3, 7.8), delivered at night time (AOR = 2.0, 95% CI: 1.02, 4.0), and neonates who had resuscitation (AOR = 2.9, 95% CI: 1.1, 7.2) showed significant association with neonatal hypothermia. Conclusion In this study, the proportion of hypothermia was high. Preterm delivery, no skin-to-skin contact within 1 hour, night-time delivery, and having resuscitation were significantly associated with neonatal hypothermia. Therefore, special attention is needed for the thermal care of preterm neonates and neonates delivered at night time. Furthermore, there should be strict adherence to cost-effective thermal care recommendations like warm resuscitation and skin-to-skin contact.
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Beletew B, Mengesha A, Wudu M, Abate M. Prevalence of neonatal hypothermia and its associated factors in East Africa: a systematic review and meta-analysis. BMC Pediatr 2020; 20:148. [PMID: 32245438 PMCID: PMC7118870 DOI: 10.1186/s12887-020-02024-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/10/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Neonatal hypothermia is a global health problem and a major factor for neonatal morbidity and mortality, especially in low and middle-income countries. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of neonatal hypothermia and its associated factors in Eastern Africa. METHODS We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search electronic databases (PubMed, Cochrane Library and Google Scholar; date of last search: 15 October 2019) for studies reporting the prevalence and associated factors of neonatal hypothermia. The data was extracted in the excel sheet considering prevalence, and categories of associated factors reported. A weighted inverse variance random-effects model was used to estimate the magnitude and the effect size of factors associated with hypothermia. The subgroup analysis was done by country, year of publication, and study design. RESULTS A total of 12 potential studies with 20,911 participants were used for the analysis. The pooled prevalence of neonatal hypothermia in East Africa was found to be 57.2% (95%CI; 39.5-75.0). Delay in initiation of breastfeeding (adjusted Odds Ratio(aOR) = 2.83; 95% CI: 1.40-4.26), having neonatal health problem (aOR = 2.68; 95% CI: 1.21-4.15), being low birth weight (aOR =2.16; 95%CI: 1.03-3.29), being preterm(aOR = 4.01; 95%CI: 3.02-5.00), and nighttime delivery (aOR = 4.01; 95% CI:3.02-5.00) were identified associated factors which significantly raises the risk of neonatal hypothermia. CONCLUSIONS The prevalence of neonatal hypothermia in Eastern Africa remains high. Delay in initiation of breastfeeding, having a neonatal health problem, being low birth weight, preterm, and nighttime delivery were identified associated factors that significantly raises the risk of neonatal hypothermia.
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Affiliation(s)
- Biruk Beletew
- Department of Nursing, College of Health Sciences, Woldia University, P.O.Box 400, Woldia, Ethiopia.
| | - Ayelign Mengesha
- Department of Nursing, College of Health Sciences, Woldia University, P.O.Box 400, Woldia, Ethiopia
| | - Mesfin Wudu
- Department of Nursing, College of Health Sciences, Woldia University, P.O.Box 400, Woldia, Ethiopia
| | - Melese Abate
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, P.O.Box 400, Woldia, Ethiopia
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Ukke GG, Diriba K. Prevalence and factors associated with neonatal hypothermia on admission to neonatal intensive care units in Southwest Ethiopia - A cross-sectional study. PLoS One 2019; 14:e0218020. [PMID: 31170252 PMCID: PMC6553781 DOI: 10.1371/journal.pone.0218020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 05/23/2019] [Indexed: 01/21/2023] Open
Abstract
Introduction Neonatal hypothermia is one of the main underlying factors associated with neonatal deaths. Objective The objective of this study was to assess the prevalence and factors associated with neonatal hypothermia on admission to neonatal intensive care units in Southwest Ethiopia. Methods Institution-based cross-sectional study design was employed between February to September 2017 at intensive care units of Arba Minch and Jinka General Hospitals. All neonates admitted to the two neonatal intensive care units during the study period were included in the study. Data were collected by four nurses who were working in the units of the hospitals through semi-structured pre-tested questionnaire and checklist. Multi-variable logistic regression was used to analyze the relationship between the dependent and independent variables using odds ratio with a confidence interval of 95% and a p-value of 0.05. Results The prevalence of neonatal hypothermia on admission to the neonatal intensive care units in this study area was 50.3%. Admission weight below 2500 gm. (AOR = 3.61, 95% CI: 2.10, 6.18), delay in initiation of breastfeeding (AOR = 2.42, 95% CI: 1.45, 4.02), early bathing (AOR = 2.63, 95% CI: 1.23, 5.63), admissions during cold season (AOR = 1.72, 95% CI: 1.04, 2.84), and presence of obstetrical complication(s) during pregnancy/labor (AOR = 2.46, 95% CI: 1.07, 5.66) were factors significantly associated with hypothermia on admission to the neonatal intensive care units. Conclusions The prevalence of neonatal hypothermia on admission to the intensive care units was high. There is a need to create awareness among the community members about the dangers of early bathing and late initiation of breastfeeding. It is also important to give attention to the newborns of mothers with obstetric complications, low-birth-weight babies and babies delivered during the cold season.
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Affiliation(s)
- Gebresilasea Gendisha Ukke
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- * E-mail:
| | - Ketema Diriba
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Demissie BW, Abera BB, Chichiabellu TY, Astawesegn FH. Neonatal hypothermia and associated factors among neonates admitted to neonatal intensive care unit of public hospitals in Addis Ababa, Ethiopia. BMC Pediatr 2018; 18:263. [PMID: 30077179 PMCID: PMC6090740 DOI: 10.1186/s12887-018-1238-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/30/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Neonatal hypothermia is a worldwide problem and an important contributing factor for Neonatal morbidity and mortality especially in developing countries. High prevalence of hypothermia has been reported from countries with the highest burden of Neonatal mortality. So the aim of this study was to assess the prevalence of Neonatal hypothermia and associated factors among newborn admitted to Neonatal Intensive Care Unit of Public Hospitals in Addis Ababa. METHODS An institutional based cross-sectional study was conducted from March 30 to April 30, 2016, in Public Hospitals in Addis Ababa and based on admission rate a total of 356 Neonates with their mother paired were enrolled for the study. Axillary temperate of the newborn was measured by a digital thermometer at the point of admission. Multivariate binary logistic regression, with 95% confidence interval and a p-value < 0.05 was used to identify variables which had a significant association. RESULTS The prevalence of Neonatal hypothermia in the study area was 64%. Preterm delivery (AOR = 4.81, 95% CI: 2.67, 8.64), age of Neonate ≤24 h old (AOR = 2.26, 95% CI: 1.27, 4.03), no skin to skin contact with their mother immediately after delivery (AOR = 4.39, 95% CI: 2.38, 8.11), delayed initiation of breastfeeding (AOR = 3.72, 95% CI: 2.07, 6.65) and resuscitation at birth (AOR = 3.65, 95%CI: 1.52, 8.78) were significantly associated with hypothermia. CONCLUSIONS The prevalence of Neonatal hypothermia in the study area was high. Preterm delivery, age ≤ 24 h old, no skin to skin contact immediately after delivery, delayed initiation of breastfeeding and resuscitation at birth were independent predictors of Neonatal hypothermia. Therefore attention is needed for thermal care of preterm newborn and use of low-cost thermal protection principles of warm chain especially on early initiation of breastfeeding, skin to skin contact immediately after delivery and warm resuscitation.
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Affiliation(s)
| | - Balcha Berhanu Abera
- School of Nursing and Midwifery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Gudayu TW. Proportion and factors associated with low fifth minute Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia. Afr Health Sci 2017; 17:1-6. [PMID: 29026371 PMCID: PMC5636237 DOI: 10.4314/ahs.v17i1.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACK GROUND New born babies with low Apgar scores are at an increased risk of perinatal morbidity and mortality. OBJECTIVE To assess proportion and factors associated with low 5th minute Apgar Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia. METHODS A cross-sectional study was conducted on singleton 261 live births from March - May, 2013. Data was collected from mother/newborn index using a structured and pre-tested questionnaire. It was then cleaned, coded and entered using EPI INFO version 3.4.3, then analyzed with IBM SPSS statistics versions 20.0. Logistic regression was used to identify significant variables with low 5th minute Apgar score. RESULT The proportion of low 5th minute Apgar score in this study was 13.8%. Factors that were significantly associated with low 5th minute Apgar score were: non-vertex fetal presentation, prolonged labor, presence of meconium stained liquor, induced/augmented labor and low birth weight. CONCLUSION Mainly obstetric factors contribute to low Apgar score. Improving labor management through implementing regular use of partograph, 1:1 midwife-client ratio and advanced electronic fetal monitoring technology is recommended.
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Affiliation(s)
- Temesgen Worku Gudayu
- Department of Midwifery, College of Medicine and Health Sciences, University of Gondar, Ethiopia
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Nlend AEN, Zeudja C, Nsoa L. [Transfer and transport of newborn babies in vital distress in Yaoundé, Cameroon: situational analysis conducted in a reference hospital]. Pan Afr Med J 2016; 25:214. [PMID: 28270906 PMCID: PMC5326266 DOI: 10.11604/pamj.2016.25.214.9642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/19/2016] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION This study aims to describe transfer modalities of newborn babies in vital distress to the ESSOS Hospital Center in Yaoundé, Cameroon. METHODS We conducted a prospective cross-sectional study from October 2014 to January 2015. Data were collected using a short questionnaire from the transfer operator. Main parameters: means of transport, reason for transfer, transfer delay, number of detours (itinerary before admission) prevalence for hypothermia, neonatal mortality rate. RESULTS We recorded 73 transfers during the study period. Nearly 1/5 (22%) of infants were born within the health district of the reference structure. 24/73 newborns were referred for tertiary care centers (33%). The main reason for transfer was prematurity (40%) followed by neonatal asphyxia (26%). Medical transfer was performed in 5/73 (7%) cases, inter-hospital transfer effected through a nurse was performed in 10/73 (13.6%) cases. The average transfer time was 17 hours, 60% of babies were transferred within the first 6 hours of life, 22% (16/73) within the first two hours of life. For more than half of newborns, a transfer to another hospital was done before admission. Hypothermia (central temperature less than 36° C) on arrival was found in 20% of cases. 15/73 (20.5%) of transferred newborns died. The mean temperature in the dead infants upon their arrival to the hospital was 35.5° C versus 37° C in the non-deceased (p = 0.006). The percentage of newborns who underwent =2 tranfers was 57% in the deceased infants versus 30% in the non-deceased ones (p=0,02). CONCLUSION In Yaoundé, transfers conditions of newborns in precarious conditions of life hinder early neonatal prognosis because of an erratic itinerary, which increases the risk of hypothermia and death. This reinforces the need for a perinatal network.
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Affiliation(s)
- Anne Esther Njom Nlend
- Centre Hospitalier d'Essos, Caisse Nationale de Prévoyance Sociale, Service de Pédiatrie et de Prévention Infantile, BP 5777 Yaoundé, Cameroun
| | - Cécile Zeudja
- Centre Hospitalier d'Essos, Caisse Nationale de Prévoyance Sociale, Service de Pédiatrie et de Prévention Infantile, BP 5777 Yaoundé, Cameroun
| | - Lydie Nsoa
- Centre Hospitalier d'Essos, Caisse Nationale de Prévoyance Sociale, Service de Pédiatrie et de Prévention Infantile, BP 5777 Yaoundé, Cameroun
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Abstract
Background: Thermal care is an important element of Baby Friendly Hospital. Aim: The objective of this study was to determine the prevalence of neonatal hypothermia and associated risk factors in healthy full term newborns at a Baby Friendly Hospital. Subjects and Methods: A cross-sectional, descriptive study was conducted on consecutively healthy full term neonates recruited during a 1 year. Temperatures were recorded immediately after birth and at the age of 1, 2 and 4 h after birth in order to estimate the prevalence of neonatal hypothermia, defined as axillary temperature less than 36.0°C. The data were collected using an especially questionnaire; data of history of abortion, parity, mode of vaginal delivery, gestational age, birth weight, newborn temperatures, time of the first skin-to-skin contact, time of first breast feeding, first wrapping and first visiting by the pediatrician. Association between neonatal hypothermia and risk factors was determined using logistic regression. Results: Axillary temperature showed 41.2%, 47.5%, 46.4% and 37.2% of the a consecutive number of 522 healthy full term neonates were moderately hypothermia immediately after birth, at 1 h, 2 h and 4 h respectively. Spontaneous labor and warming room were associated with decreased risk of hypothermia. A persistently high prevalence of neonatal hypothermia was shown within the first 4 h of vaginal birth. All analyses were carried out using the SPSS version 17.0 (Chicago IL, USA). Test of the associations were done, stepwise multiple logistic regressions. Odds ratios (ORs) were assessed using maximum likelihood and associated 95% confidence intervals were computed. A P ≤ 0.05 was considered to be statistically significant Conclusion: The findings of this study indicated that a high prevalence of neonatal hypothermia was identified among healthy full term newborn in a Baby Friendly Hospital Initiative. Therefore, it is necessary to emphasize on the development “warm chain” in preventing neonatal hypothermia in Baby Friendly Hospital.
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Affiliation(s)
- Ma Delavar
- Fatemezahra Infertility and Reproductive Health Research Center, Department of Midwifery, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Z Akbarianrad
- Non-Communicable Pediatric Disease Research Center, Department of Pediatrics, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Mm Mansouri
- Student Research Committee, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - M Yahyapour
- Student Research Committee, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
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Whitworth E, Anderson BA, Buffington ST, Braun J. Prevention of Neonatal Hypothermia: A Skin-to-Skin Practices Education Project in Rural Uganda. Int J Childbirth 2014; 4:17-24. [DOI: 10.1891/2156-5287.4.1.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE: In low resource areas, neonatal hypothermia is an important source of neonatal morbidity. Separating newborns from their mothers at birth puts neonates at risk for hypothermia. The Teso Safe Motherhood Project (TSMP) in Soroti, Uganda provides birth center care for women in conflict areas of Northern Uganda. After conducting a needs assessment at TSMP, a continuing education project was developed to facilitate change in clinical practice to enhance prevention and recognition of neonatal hypothermia, including implementation of skin-to-skin practices at birth.STUDY DESIGN: This education project employed multiple learning strategies including pretest and posttest questionnaires, group discussion of cultural beliefs and practices, didactic education, participation in creative informational art, and demonstration, supervision, and return demonstration of skills.MAJOR FINDINGS: At the completion of the program, 100% of participants demonstrated a statistically significant increase in both knowledge and skills in the prevention and management of neonatal hypothermia (p = .011).MAIN CONCLUSION: The participants reported that this continuing education project enhanced their skills in neonatal hypothermia prevention and management. The cost-effective strategies employed in this project can be replicated in low resource settings, contributing to decreased mortality and morbidity from newborn hypothermia.
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Abstract
Over the last 50 years an increasing amount of evidence on neonatal resuscitation and stabilisation practices has led to written recommendations on all aspects of newborn care in the first few minutes of life. Much evidence for thermoregulatory management of both term and preterm infants has existed for decades and more recently research has identified new techniques to maintain normothermia in newly born infants. The use of increased environmental temperatures, skin-to-skin care, radiant warmers, plastic coverings and hats, exothermic mattresses and heated humidified gases have or are undergoing evaluation. However, despite the apparent acceptance of these techniques, a substantial number of infants continue to become hypothermic soon after delivery, leading to an increased risk of comorbidities and of death. Gaps in our knowledge remain and further research opportunities are available. However, we must also ensure that established thermoregulatory methods for which the evidence already exists are given as much emphasis as other aspects of newborn care and are implemented meticulously in all healthcare settings.
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Affiliation(s)
- Helen Chitty
- Department of Neonatology, The James Cook University Hospital, Marton Road, Middlesbrough, Teesside TS4 3BW, UK
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Lunze K, Bloom DE, Jamison DT, Hamer DH. The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival. BMC Med 2013; 11:24. [PMID: 23369256 PMCID: PMC3606398 DOI: 10.1186/1741-7015-11-24] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 01/31/2013] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND To provide evidence on the global epidemiological situation of neonatal hypothermia and to provide recommendations for future policy and research directions. METHODS Using PubMed as our principal electronic reference library, we searched studies for prevalence and risk factor data on neonatal hypothermia in resource-limited environments globally. Studies specifying study location, setting (hospital or community based), sample size, case definition of body temperature for hypothermia, temperature measurement method, and point estimates for hypothermia prevalence were eligible for inclusion. RESULTS Hypothermia is common in infants born at hospitals (prevalence range, 32% to 85%) and homes (prevalence range, 11% to 92%), even in tropical environments. The lack of thermal protection is still an underappreciated major challenge for newborn survival in developing countries. Although hypothermia is rarely a direct cause of death, it contributes to a substantial proportion of neonatal mortality globally, mostly as a comorbidity of severe neonatal infections, preterm birth, and asphyxia. Thresholds for the definition of hypothermia vary, and data on its prevalence in neonates is scarce, particularly on a community level in Africa. CONCLUSIONS A standardized approach to the collection and analysis of hypothermia data in existing newborn programs and studies is needed to inform policy and program planners on optimal thermal protection interventions. Thermoprotective behavior changes such as skin-to-skin care or the use of appropriate devices have not yet been scaled up globally. The introduction of simple hypothermia prevention messages and interventions into evidence-based, cost-effective packages for maternal and newborn care has promising potential to decrease the heavy global burden of newborn deaths attributable to severe infections, prematurity, and asphyxia. Because preventing and treating newborn hypothermia in health institutions and communities is relatively easy, addressing this widespread challenge might play a substantial role in reaching Millennium Development Goal 4, a reduction of child mortality.
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Affiliation(s)
- Karsten Lunze
- Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2077, Boston, Massachusetts 02118, USA
| | - David E Bloom
- Department of Global Health and Population, 665 Huntington Avenue, Building I 12th Floor, Boston, Massachusetts 02115, USA
| | - Dean T Jamison
- Department of Global Health, University of Washington, 325 9th Avenue, Ste. 359931, Seattle, WA 98104, USA
| | - Davidson H Hamer
- Department of International Health and Medicine, Boston University Schools of Public Health and Medicine, 801 Massachusetts Avenue, Boston, Massachusetts 02118, USA
- Zambia Centre for Applied Health Research and Development, 4649 Beit Road, Lusaka, Zambia
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Abstract
This study aimed to determine the efficacy of interactive workshop on the management of hypothermia and its impact on pediatric nurses' training. This is a pretest-to-posttest quasi-experimental descriptive study. Thirty pediatric nurses attended an interactive lecture-based interactive workshop on the management of hypothermia. Participants had to accept an invitation to the presentation before the training event. They completed the lecture, and a multiple-choice question test before and after the lecture was given. There was a significant improvement in mean test scores after the lecture when compared with those before the lecture (mean [SD], 15.5 [1.3] vs 5.0 [1.7], P < 0.001). The information gained in this study will be valuable as a baseline for further research and help guide improvements in the management of hypothermia with the ultimate goal of enhancing safe and quality patient care.
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Abstract
Hypothermia among newborns is considered an important contributor to neonatal morbidity and mortality in low-resource settings. However, in these settings only limited progress has been made towards understanding the risk of mortality after hypothermia, describing how this relationship is dependent on both the degree or severity of exposure and the gestational age and weight status of the baby, and implementing interventions to mitigate both exposure and the associated risk of poor outcomes. Given the centrality of averting neonatal mortality to achieving global milestones towards reductions in child mortality by 2015, recent years have seen substantial resources and efforts implemented to improve understanding of global epidemiology of neonatal health. In this article, a summary of the burden, consequences, and risk factors of neonatal hypothermia in low-resources settings is presented, with a particular focus on community-based data. Context-appropriate interventions for reducing hypothermia exposure and the role of these interventions in reducing global neonatal mortality burden are explored.
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Abstract
BACKGROUND Hypothermia is increasingly recognized as a major cause of neonatal morbidity and mortality in resource poor settings. High prevalence of hypothermia has been reported widely from warmer high mortality regions of Africa and South Asia. The World Health Organization recognizes newborn thermal care as a critical and essential component of essential newborn care; however, hypothermia continues to remain under-documented, under-recognized and under-managed. OBJECTIVE This review aims to provide a thorough patho-physio-epidemiological discussion of neonatal hypothermia applied to local risk factors within the developing country context with particular emphasis on prevention, recognition and management. METHOD All available published literature on neonatal hypothermia relevant to resource poor settings were reviewed. Studies from the developing country settings were primarily reviewed for epidemiology, domiciliary risk factors as well as potential interventions for thermal care. RESULT AND DISCUSSION Functional integrity and efficiency of biological systems is critically dependent on an optimal and very narrow range of core body temperature. Risk factors for neonatal hypothermia differ markedly within low resource settings. A combination of physiological, behavioral and environmental factors universally put all newborns, irrespective of birth weight, at risk of hypothermia. The knowledge deficit along the continuum from health providers to primary care givers has sustained the silent epidemic of hypothermia. The challenges of recognition, understanding of local risk factors and communication have meant a lack of informed thermal care for newborns. Simple, feasible interventions exist, but need to be applied, based on local risk factors that disrupt the warm chain. Further research is needed to document local risk factors, develop better techniques for recognition, evaluation of thermal care within essential newborn care and communication strategies for program effectiveness.
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Affiliation(s)
- V Kumar
- Department of International Health, International Center for Advancing Neonatal Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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