Neonatal hypothermia in Northern Uganda: a community-based cross-sectional study

Abstract

ObjectiveTo determine the prevalence, predictors and case fatality risk of hypothermia among neonates in Lira district, Northern Uganda.SettingThree subcounties of Lira district in Northern Uganda.DesignThis was a community-based cross-sectional study nested in a cluster randomised controlled trial.ParticipantsMother–baby pairs enrolled in a cluster randomised controlled trial. An axillary temperature was taken during a home visit using a lithium battery-operated digital thermometer.Primary and secondary outcomesThe primary outcome measure was the prevalence of hypothermia. Hypothermia was defined as mild if the axillary temperature was 36.0°C to <36.5°C, moderate if the temperature was 32.0°C to <36.0°C and severe hypothermia if the temperature was <32.0°C. The secondary outcome measure was the case fatality risk of neonatal hypothermia. Predictors of moderate to severe hypothermia were determined using a generalised estimating equation model for the Poisson family.ResultsWe recruited 1330 neonates. The prevalence of hypothermia (<36.5°C) was 678/1330 (51.0%, 95% CI 46.9 to 55.1). Overall, 32% (429/1330), 95% CI 29.5 to 35.2 had mild hypothermia, whereas 18.7% (249/1330), 95% CI 15.8 to 22.0 had moderate hypothermia. None had severe hypothermia. At multivariable analysis, predictors of neonatal hypothermia included: home birth (adjusted prevalence ratio, aPR, 1.9, 95% CI 1.4 to 2.6); low birth weight (aPR 1.7, 95% CI 1.3 to 2.3) and delayed breastfeeding initiation (aPR 1.2, 95% CI 1.0 to 1.5). The case fatality risk ratio of hypothermic compared with normothermic neonates was 2.0 (95% CI 0.60 to 6.9).ConclusionThe prevalence of neonatal hypothermia was very high, demonstrating that communities in tropical climates should not ignore neonatal hypothermia. Interventions designed to address neonatal hypothermia should consider ways of reaching neonates born at home and those with low birth weight. The promotion of early breastfeeding initiation and skin-to-skin care could reduce the risk of neonatal hypothermia.Trial registration numberClinicalTrial.gov as NCT02605369.

Efficacy of early initiation of breastfeeding (EIB) for preventing hypothermia in newborns

“…5) The promotion of early initiation of breastfeeding and providing skin-to-skin care from mother to baby can prevent the risk of hypothermia in neonates. Babies born with low weight and babies born to families with poor economic status can initiate early breastfeeding and perform skin-toskin care as an intervention and recommendation for low-cost promotion in preventing hypothermia (Mukunya et al, 2021). 6) Delay in initiating early breastfeeding, low birth weight, premature, low Apgar score at 5 minutes, night delivery, bathing within 24 hours after delivery, and not making skin-to-skin contact between mother and baby are risk factors for hypothermia in newborns (Gayatri & Dasvarma, 2020).…”

Use of access port covers in transport incubators to improve thermoregulation during neonatal transport

“…These risks in newborns should be evaluated in future studies. Finally, as a newborn was not placed in the transport incubator, we were unable to assess the effects on actual body temperature, and the effects of gestational weeks, birth weight, and congenital diseases of neonates; use of warm blankets, plastic wrapping, caps, and thermal mattresses; and skin-to-skin care on neonatal hypothermia are uncertain 8,9 . Owing to the risks of hypothermia on neonatal health outcomes and mortality, examining the effects of lower incubator temperature on body temperature is not feasible.…”

“…In the first 10-20 min at birth, no intervention to prevent neonatal heat loss may make the neonatal body temperature fall by 2-4 °C7 . Therefore, various measures are used in the NICU to prevent neonatal hypothermia, including control of environmental temperature; use of warm blankets, plastic wrapping, caps, and thermal mattresses; and skin-to-skin care 8,9 .…”

Prevalence and Factors Associated with Hypothermia among Neonates in Regional Referral Hospitals in Dar es Salaam, Tanzania

“…In, Nigeria, mothers claimed to have discarded colostrum in the first 24 hr postpartum and infants were fed on glucose water or herbal preparations (Omotola & Akinyele, 1985). Reports from Guinea-Bissau and Uganda suggest that mothers had negative cultural perceptions about colostrum and some communities believe that colostrum is dirty milk and mothers delay feeding to allow the milk to clear (Gunnlaugsson, Da Siva, & Smedmann, 1992;Mukunya, Tumwine, Nankabirwa, Odongkara, Arach et al, 2021).…”