Hypothermia on Admission: a Risk Factor for Death in Newborns Referred to the Pernambuco Institute of Mother and Child Health

Abstract

The objective of this study was to determine the mortality risk related to hypothermia at the moment of admission and other factors such as clinical and geographical related to the transportation of the newborns admitted to the Instituto Materno Infantil de Pernambuco IMIP from 8 March to 11 June 2000. A prospective study involving 320 newborns arriving from home or health centres was carried out. Babies that were dead on arrival or subsequently transferred to other units were excluded. The risk of death was determined according to exposure to hypothermia and other types of exposure, using logistical regression. The risk of death was higher (RR = 3.09; CI = 2.15-4.43) in the group exposed to moderate hypothermia (temperature between 32.5 degrees C and 35.99 degrees C) than in the non-exposed group (temperature equal to or greater than 36.00 degrees C). The relative risk of death was also higher for newborns with a weight of less than 2500 g, that were less than 1 day old, respiratory distress syndrome, premature babies or with congenital malformations, that had used oxygen and/or intravenous infusion during transit, that came from the interior and that had travelled more than 150 km. In the final result of the multivariate analysis, sepsis ('adjusted' RO = 6.23; 95% CI = 5.66-6.80), respiratory distress syndrome ('adjusted' RO = 5.28; 95% CI = 5.03-5.59), moderate hypothermia ('adjusted' RO = 3.49, 95% CI = 3.18-3.81), and distance undertaken greater than 50 km ('adjusted' RO = 2.39; 95% CI = 2.14-2.63) remained. Hypothermia on admission showed itself to be an important and independent risk factor for neonatal death.

Neonatal hypothermia in low resource settings: a review

“…3,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Uniform adoption and application of the standard WHO definition is fundamental to coordinated advancements in detection and management, but hypothermia continues to be variably defined, leading to under-recognition and under-reporting, and inadvertent denial of care to those who are misclassified but in need of care.…”

“…14 The risk of death among hypothermic newborns in an urban Indian hospital was highly correlated with the length of time it took to transfer and admit the newborn from the delivery ward to the neonatal intensive care unit. 70 Silveira et al 71 recommend in utero transport whenever possible, encouraging women to deliver in a hospital to reduce the possibility of a post-labor transport if the baby requires extra care after birth. When hospital fees were introduced into Nigeria in the early 1980s, an increased rate of home deliveries among women who could no longer afford hospital care in one region caused a significant increase in hypothermia among infants who required post-delivery transport to the hospital.…”

“…Neonatal hypothermia has been documented (Panel 1) throughout the developing world, and is an important source of neonatal [70][71][72] Signs/Symptoms: Lethargy, poor feeding, weak cry, reduced movements, peripheral edema and swelling of limb tissues, skin cold to touch. 7 Prevention and Management: Behaviors and appropriate technology that maintain the appropriate thermal environment and prevent heat loss, including STSC and breastfeeding, 60,90,99 radiant warmers and incubators (in areas of consistent electricity), 20 heated water-filled mattresses, 20 plastic wraps and bags, 79,100 and topical agents (including oil massage).…”

Hypothermia and Related Factors in High-Risk Infants

“…All identified studies from Africa to date are hospital based, report poor newborn practices and high prevalences of newborn hypothermia ranging from 44% to 69% in Zambia [25,26] to 53% in Ethiopia [27], 62% to 68% in Nigeria [28], and 85% in Zimbabwe [29]. Large studies from other countries confirm the global tendency for newborn hypothermia in different climate conditions, from Asia (China) (cited in [30]), [31], the Middle East (Iran) [32,33] and South America (Brazil) [34].…”

Heat Loss Prevention in the Delivery Room for Preterm Infants: A National Survey of Newborn Intensive Care Units

“…Hypothermia on admission is an important factor in neonatal morbidity and mortality. 1 Hypothermia is associated with glucose and electrolyte abnormalities, metabolic acidosis, renal failure, infection, apnea, hypotension, bradycardia, respiratory distress, thrombocytopenia, and bleeding. 2 Despite World Health Organization 3 recommendations to keep the delivery room temperature at least 251C, it is common for extremely low birth weight (ELBW) infants to be exposed to cold environments in the delivery room after birth and through stabilization.…”