Ending Neonatal Deaths From Hypothermia in Sub-Saharan Africa: Call for Essential Technologies Tailored to the Context

Pisoni, Giorgia Brambilla; Gaulis, Christine; Suter, Silvan; Rochat, Michel A; Makohliso, Solomzi; Roth‐Kleiner, Matthias; Kyokan, Michiko; Pfister, Riccardo; Schönenberger, Klaus

doi:10.3389/fpubh.2022.851739

Cited by 10 publications

(10 citation statements)

References 36 publications

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“…The main warming devices currently available and intended for low-resource settings are radiant warmers, incubators, and conductive warmers ( 16 ). Table 2 summarises their main characteristics with advantages and limitations.…”

Section: Resultsmentioning

confidence: 99%

“…WHO recommends using radiant warmers or incubators for unstable neonates weighing 2000g or less, or for stable neonates below 2,000 g who cannot receive skin-to-skin care ( 14 ). In low-resource settings, however, these warming devices are often unavailable ( 15 ), either broken down, with little chance of being made functional again on site ( 16 ) or kept in storage due to missing parts, insufficient power-grid or lack of consumables ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

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Neonatal warming devices: What can be recommended for low-resource settings when skin-to-skin care is not feasible?

2023

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Hypothermia occurs frequently among clinically unstable neonates who are not suitable to place in skin-to-skin care. This study aims to explore the existing evidence on the effectiveness, usability, and affordability of neonatal warming devices when skin-to-skin care is not feasible in low-resource settings. To explore existing data, we searched for (1) systematic reviews as well as randomised and quasi-randomised controlled trials comparing the effectiveness of radiant warmers, conductive warmers, or incubators among neonates, (2) neonatal thermal care guidelines for the use of warming devices in low-resource settings and (3) technical specification and resource requirement of warming devices which are available in the market and certified medical device by the US Food and Drug Administration or with a CE marking. Seven studies met the inclusion criteria, two were systematic reviews comparing radiant warmers vs. incubators and heated water-filled mattresses vs. incubators, and five were randomised controlled trials comparing conductive thermal mattresses with phase-change materials vs. radiant warmers and low-cost cardboard incubator vs. standard incubator. There was no significant difference in effectiveness between devices except radiant warmers caused a statistically significant increase in insensible water loss. Seven guidelines covering the use of neonatal warming devices show no consensus about the choice of warming methods for clinically unstable neonates. The main warming devices currently available and intended for low-resource settings are radiant warmers, incubators, and conductive warmers with advantages and limitations in terms of characteristics and resource requirements. Some devices require consumables which need to be considered when making a purchase decision. As effectiveness is comparable between devices, specific requirements according to patients' characteristics, technical specification, and context suitability must play a primary role in the selection and purchasing decision of warming devices. In the delivery room, a radiant warmer allows fast access during a short period and will benefit numerous neonates. In the neonatal unit, warming mattresses are low-cost, effective, and low-electricity consumption devices. Finally, incubators are required for very premature infants to control insensible water losses, mainly during the first one to two weeks of life, mostly in referral centres.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neonatal warming devices: What can be recommended for low-resource settings when skin-to-skin care is not feasible?

2023

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“…Underfunded health systems, shortages of human resources Occurrence of neonatal hypothermia and associated risk factors among low birth weight (LBW) infants in Accra, Ghana for health, lack of reliable electricity and limited financial resources have hindered the use of incubators and other technologies in low-resource settings. 26 However, skin-toskin contact is widely recognized as an inexpensive, effective and safe way to achieve and maintain stable neonatal temperature and prevent hypothermia, especially among clinically stable LBW and preterm infants in low-resource settings. 27 Kangaroo mother care (KMC) which includes early, continuous, and prolonged skin-to-skin contact and breastfeeding, has been shown to reduce hypothermia, the incidence of infections, and the risk of mortality, while promoting weight gain and nurturing parent-infant attachment.…”

Section: Discussionmentioning

confidence: 99%

Occurrence of neonatal hypothermia and associated risk factors among low birth weight (LBW) infants in Accra, Ghana

Pellegrino

Kanyangarara

Agbinko-Djobalar

et al. 2023

Journal of Global Health Reports

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Background Neonatal hypothermia is a prominent issue in low-resource settings. Preterm and low birth weight (LBW) infants are at increased risk for developing hypothermia. If left untreated, hypothermia can lead to hypoxia, sepsis, hypoglycemia, apnea, and poor weight gain in neonates, contributing to neonatal morbidity and mortality. Identifying risk factors for neonatal hypothermia is important, especially in low-resource settings, where the burden of neonatal mortality is highest. The study sought to describe the distribution of neonatal hypothermia and examine risk factors associated with neonatal hypothermia among LBW infants admitted to Korle-Bu Teaching Hospital in Accra, Ghana. Methods Infants in the neonatal intensive care unit (NICU) at Korle-Bu Teaching Hospital, who were less than 28 days old, weighing less than <2,500 grams, and clinically stable, were enrolled. Infants of mothers under 18 years old and those expected to be discharged within 24 hours were excluded from the study. A standardized questionnaire was administered to collect information on the mother, infant, pregnancy, and birth characteristics. Axillary temperature readings were taken every 4 hours over a 24-hour monitoring period and during hypothermic events detected by the continuous temperature monitoring bracelet. Univariate and multivariate linear regression analyses with generalized estimating equations were used to examine risk factors associated with temperature. Results Of the 254 infants included in the analysis, 42.1% were male, 49.6% were very LBW (<1,500 grams), and 94.1% were preterm (<37 weeks). Of the 1,948 temperature readings, 44.5% were hypothermic (<36.5oC). Hypothermia occurred in 85.8% of infants during the 24-hour monitoring period. Multivariate linear regression demonstrated that being very LBW, having no skin-to-skin contact immediately after birth, not being wrapped or treated in an incubator at the time of temperature, and mixed feeding (compared to exclusive breastfeeding) were associated with lower neonatal temperatures. Conclusions Neonatal hypothermia was common among infants admitted to the NICU. The findings highlight the importance of thermal practices such as wrapping, exclusive breastfeeding and skin-to-skin contact. Increased education to promote thermal care is needed.

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“…Continuous efforts to reduce hypothermia after Caesarian delivery and minimize neonatal DAMA would likely result in substantial improvement of outcomes for infants in many parts of the world. It is essential to have available locally-appropriate technologies to avoid hypothermia after birth ( 5 ) as well as enable effective screening of neonatal jaundice ( Suzuki et al ). To reduce risk of complications of neonatal hypoxic ischemic encephalopathy in LMIC, hypothermia treatment is warranted but challenging to perform [ Birhane et al ( 5 ), Boo et al ].…”

mentioning

confidence: 99%

“…It is essential to have available locally-appropriate technologies to avoid hypothermia after birth ( 5 ) as well as enable effective screening of neonatal jaundice ( Suzuki et al ). To reduce risk of complications of neonatal hypoxic ischemic encephalopathy in LMIC, hypothermia treatment is warranted but challenging to perform [ Birhane et al ( 5 ), Boo et al ]. Other papers emphasized the need for newborn resuscitation training with video-recording ( Olson et al ), and that intramuscular epinephrine in a neonatal animal model ( Berkelhamer et al ) was not effective.…”

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confidence: 99%

Editorial: Neonatal health in low- and middle-income countries. Now is the time

Steenhoff

Coffin

et al. 2023

Front. Pediatr.

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on the Research Topic Neonatal health in low-and middle-income countries. Now is the time The first 28 days after birth-the neonatal period-is the most vulnerable month for a child (1). The global "Every Newborn" action plan, which was endorsed by the WHO General Assembly in 2014, sets out an ambitious vision of a world with no preventable stillbirths or neonatal deaths (2). The action plan, endorsed in 2014 by 194 member states, articulates a goal that all countries reach the target neonatal mortality rate (NMR) of 12 or less newborn deaths per 1,000 live births by 2030, as well as commit to ongoing work to reduce death and disability. Achieving this interim goal is essential to ensure that no newborn is left behind. This metric was adopted as a target for Sustainable Development Goal (SDG) Target 3.2 (3). Despite a decline of more than 50% in the global neonatal mortality between 2000 and 2021, 2.4 million neonatal deaths still occur each year. The majority (79%) of these deaths take place in countries in South Asia and Sub-Saharan Africa, where the social system and health care settings are inadequately resourced.This editorial team was pleased to use this special issue as an opportunity to identify new frontiers in global neonatal health, especially in the context of two global crises-the SARS-CoV-2 pandemic and climate change. We received 65 manuscripts, of which 40 (62%) were accepted. These 40 included 27 (68%) original research manuscripts, five (13%) brief research reports, three (8%) perspective pieces, two (5%) reviews, one (3%) case report, one (3%) on hypothesis and theory, and one (3%) on methods.

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Ending Neonatal Deaths From Hypothermia in Sub-Saharan Africa: Call for Essential Technologies Tailored to the Context

Cited by 10 publications

References 36 publications

Neonatal warming devices: What can be recommended for low-resource settings when skin-to-skin care is not feasible?

Neonatal warming devices: What can be recommended for low-resource settings when skin-to-skin care is not feasible?

Occurrence of neonatal hypothermia and associated risk factors among low birth weight (LBW) infants in Accra, Ghana

Editorial: Neonatal health in low- and middle-income countries. Now is the time

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