Postnatal hypothermia and cold stress among newborn infants in Nepal monitored by continuous ambulatory recording.

Abstract

Aims-To describe the pattern of hypothermia and cold stress after delivery among a normal neonatal population in Nepal; to provide practical advice for improving thermal care in a resource limited maternity hospital. Methods-The principal government funded maternity hospital in Kathmandu, Nepal, with an annual delivery rate of 15 000 (constituting 400/o of all Kathmandu Valley deliveries), severe resource limitations (annual budget £250 000), and a cold winter climate provided the setting. Thirty five healthy term neonates not requiring special care were enrolled for study within 90 minutes ofbirth. Continuous ambulatory temperature monitoring, using microthermistor skin probes for forehead and axilla, a flexible rectal probe, and a black ball probe placed next to the infant for ambient temperature, was carried out. All probes were connected to a compact battery powered Squirrel Memory Logger, giving a temperature reading to 0.2°C at five minute intervals for 24 hours. Severity and duration of hypothermia, using cutoff values of core temperature less than 36°C, 34°C, and 32°C; and cold stress, using cutoff values of skin-core (forehead-axilla) temperature difference greater than 3°C and 4°Cwere the main outcome measures.Results-Twenty four hour mean ambient temperatures were generally lower than the WHO recommended level of 25°C (median 22.3°C, range 15.1-27.5°C). Postnatal hypothermia was prolonged, with axillary core temperatures only reaching 36°C after a mean of 6.4 hours (range 0 -21.1; SD 4.6).There was persistent and increasing cold stress over the first 24 hours with the core-skin (axi11ary-forehead) temperature gap exceeding 3°C for more than half of the first 24 hours. Conclusions-Continuous ambulatory recording identifies weak links in the "warm chain" for neonates. The severity and duration of thermal problems was greater than expected even in a hospital setting where some of the WHO recommendations had already been implemented. (Arch Dis Child 1996;75:F42-F45)

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

“…Studies in Nepal using continuous temperature monitoring have indicated that thermal stress may be extremely common among newborn infants; 80% of hospital-born infants became hypothermic soon after birth. 472 In another maternity hospital study in Nepal, 85% of newborns had a temperature Ͻ36°C within 2 hours of birth. 473 Similarly, in facility-based studies in Ethiopia, 474 Zambia, 475 and Zimbabwe, 476 one half to two thirds of newborns had hypothermia.…”

Outcome at 1 year of neonatal encephalopathy in Kathmandu, Nepal

“…Perinatal mortality rates are considerably higher in low-income regions (57 per 1000 total births) than in highincome regions (11 per 1000) (WHO 1996b). We predicted that the prevalence of encephalopathy would likewise be higher and that concurrent adverse perinatal factors common in low-income countries such as neonatal hypothermia (Ellis et al 1996), hypoglycaemia (Anderson et al 1993), and late neonatal infection (Jalil et al 1993) might affect outcome. This study reports on the 1-year outcome of a cohort of term infants with NE who were recruited during an 18-month study.…”

Differences in thermal adaptation of infants delivered at primary or tertiary care facilities in India

“…[1][2][3][4][5] These studies were mainly carried out in a controlled optimal environment. 6,7 In contrast, in developing countries the environment in the delivery rooms (DRs) is uncontrolled. 8,9 Studies in developing countries, including India, have demonstrated high incidence of hypothermia in neonatal period.…”