No abstract

Although skin-to-skin contact (or kangaroo mother care, KMC) for preterm infants is a practical alternative to incubator care, no studies have compared these methods using continuous ambulatory temperature monitoring. To compare thermal regulation in low birthweight infants (< 2000 g) managed by KMC alternating with conventional care (CC) and to determine the acceptability to mothers of KMC, an experimental study with a crossover design with observational and qualitative data collected on temperature patterns and mothers attitudes to skin-to-skin care was conducted in the neonatal wards of three hospitals in Lagos, Nigeria. Thirteen eligible infants were nursed by their mothers or surrogates in 38 4-hour sessions of KMC and the results compared with 38 sessions of incubator care. The risk of hypothermia was reduced by > 90% when nursed by KMC rather than conventional care, relative risk (RR) 0.09 (0.03-0.25). More cases of hyperthermia (> 37.5 degrees C) occurred with KMC, and coreperiphery temperature differences were widened, but the risk of hyperthermia > 37.9 degrees C (RR 1.3, 0.9-1.7) was not significant. Micro-ambient temperatures were higher during KMC, although the average room temperatures during both procedures did not differ significantly. Mothers felt that KMC was safe, and preferred the method to CC because it did not separate them from their infants, although some had problems adjusting to this method of care. Where equipment for thermal regulation is lacking or unreliable, KMC is a preferable method for managing stable low birthweight infants.

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)

Among a cross-sectional sample (stratified by weight and age after birth) of 226 uncomplicated term newborns from the delivery and postnatal wards of a busy government maternity hospital in Kathmandu, the period prevalence of hypoglycaemia (corrected blood glucose of < 2.6 mmol/l) during the first 50 hours after birth was 38 per cent. (This compares with a reported prevalence rate of 12 per cent from studies of uncomplicated term newborns in the UK.) Hypothermia, young maternal age, low birth weight and early sampling after birth were independent risk factors for hypoglycaemia. Of 31 infants studied longitudinally during the same period, 27 (87 per cent) had at least one blood glucose measurement of < 2.6 mmol/l and 25 (81 per cent) a rectal temperature of < 35.5 degrees C. Fourteen infants (44 per cent) had three or more episodes of hypoglycaemia and seven infants (22 per cent) had three or more episodes of hypothermia. Hypoglycaemia is a common, preventable and neglected problem in many maternity hospitals in developing countries. Simple low-cost measures to reduce the incidence of hypoglycaemia may have a major impact on early infant mortality and neurodevelopmental sequelae of perinatal origin.

SUMMARY Abnormalities detected by a mechanical sector scanner were compared ‘blind’ with autopsy findings in the brains of 56 infants born at less than 33 weeks gestation. Intraventricular haemorrhage was found in 53 of 112 hemispheres and had been accurately diagnosed by ultrasound (sensitivity 91 per cent; specificity 81 per cent). Isolated germinal layer haemorrhage was less successfully identified (sensitivity 61 per cent; specificity 78 per cent); false‐positive diagnoses were partly due to difficulty in distinguishing haemorrhage from the normal choroid plexus in extremely preterm infants. Haemorrhagic parenchymal lesions were correctly identified in nine infants (sensitivity 82 per cent; specificity 97 per cent). Only 11 of 39 hemispheres with histological evidence of hypoxic‐ischaemic injury, without marked bleeding, were correctly identified by ultrasound (sensitivity 28 per cent), mainly because of failure to detect small areas of periventricular leucomalacia and diffuse gliosis. 10 hemispheres with periventricular echodensities thought to represent leucomalacia showed no histological evidence of hypoxic‐ischaemic injury (specificity 86 per cent). Ventricular dilatation in seven infants was always associated with evidence of hypoxic‐ischaemic injury at autopsy. RÉSUMÉ Précision du diagnostic échographique des lésions vérifiées post‐mortem dans le cerveau des grands prématures Les anomalies détectées à une échographie mécanique sectorielle ont été comparées ‘à l'aveugle’ avec des données d'autopsie pour les cerveaux de 56 nourrissons, nés à moins de 33 semaines de gestation. Une hémorragie intraventriculaire a été trouvée à l'autopsie dans 53 des 112 hémisphéres et a été diagnostiquée avec précision par I'échographie (sensibilité 91 pour cent; spécificité 81 pour cent). L'hémorragie isolée de la couche germinative a été identifiée avec moins de succés (sensibilité 61 pour cent; spécificité 78 pour cent). Les diagnostics faux‐positifs ont été en partie liés à une difficulté de distinguer I'hémorragie du plexus choroide normal chez les grands prématurés. Les lésions d'hémorragies parenchymateuses ont été correctement identifiées chez neuf nourrissons (sensibilité 82 pour cent; spécificité 97 pour cent). La réalité histologique de lésions hypoxiques‐ischémiques sans saignement marqué n'a été correctement identifiée par échographie que dans 11 des 39 hémisphéres (sensibilité 28 pour cent), principalement en raison de l'échec de détection de zones limitées de leucomalacie périventriculaire et de gliose diffuse. Pour 10 hémisphéres oú des échodensités périventriculaires avaient été interprêtées comme leucomalacies, il n'y avait pas d'évidence histologique de lésions hypoxiques‐ischémiques (spécificité 86 pour cent). La dilatation ventriculaire chez sept nourrissons était toujours associée à des lésions hypoxiques‐ischémiques évidentes à I'autopsie. ZUSAMMENFASSUNG Genauigkeit der Ultraschalldiagnose von pathologisch verifzierten Hirnläsionen sehr junger Frühgeborener Bei 56 Neugeborenen mit einem Gestationsalt...