No abstract

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.

Background We report a case of an elderly woman who developed an Ischemic stroke. Thrombolytic therapy was successful as evidenced by functional and neurological improvement. This is the first well-documented case of such intervention in Korle-Bu Teaching Hospital (KBTH), Stroke unit. Case Information: Our patient is a 64-year-old woman who is known to have hypertension and diabetes. She had been relatively well until she developed an ischemic stroke. Five days prior to this, she had experienced two episodes of Transient Ischemic Attacks (TIA). Thrombolytic therapy was successful with Tenecteplase given at 4.5 hours post-episode. MRS (Modified Ranking Scale) and NHISS (National Health Institute of Stroke Scale) pre thrombolysis were 4 and 10 respectively. NHISS 2hrs post thrombolysis was 4. MRS and NHISS 24hrs post thrombolysis were 0 and 1 respectively. We sought to identify why only a few cases of thrombolytic therapies are carried out in developing countries, and we found that the strict eligibility for the initiation of therapy was the main barrier. Conclusion In acute infarctive stroke management, intervention is time-dependent, as thrombolysis has been shown to prevent permanent disability if instituted early enough. We believe that many more individuals may benefit from thrombolytic therapy if more studies are carried out with systematic reviews of case reports and research, factoring in key challenges met in middle to low-income countries.