Evaluation of WHO Classification of Hypothermia in Sick Extramural Neonates as Predictor of Fatality

Abstract

The objective of this study is to correlate the severity of hypothermia in sick extramural neonates with fatality and physiological derangements. This is a prospective observational study carried out at the referral neonatal unit of a teaching hospital admitting extramural neonates. The subjects comprised of 100 extramural hypothermic neonates transported to the Referral neonatal unit. Neonates weighing more than 1000 g, with abdominal skin temperature less than 36.5 degrees C at admission were included in the study. Hypothermia was classified as per WHO recommendations. Clinical features including age, weight, gestational age, clinical diagnosis, vitals, place of delivery, details of transportation and capillary filling time were recorded at the time of admission. Oxygen saturation was recorded by a pulse oximeter. Samples for sepsis screen, blood culture and blood glucose were taken at admission. During the study it was observed that fatality was 39.3% in mildly hypothermic babies, 51.6% in moderately hypothermic babies and 80% in severely hypothermic babies. However, the presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g were associated with more than 50% fatality even in mildly hypothermic babies. When moderate hypothermia was associated with hypoxia or shock, the fatality was 83.3% and 90.9% respectively. Similarly, mild hypothermia with hypoglycemia was associated with 71.4% fatality. The conclusion drawn from this study is that the WHO classification of severity of hypothermia correlates with the risk of fatality. However, it considers only body temperature to classify severity of hypothermia. The presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g should be considered adverse factors in hypothermic neonates. Their presence should classify hypothermia in the next higher category of severity in WHO classification.

Hypothermia in very low birth weight infants: distribution, risk factors and outcomes

“…[1][2][3] Our study revealed higher odds of IVH with moderate hypothermia and higher odds of death with both severe and moderate hypothermia. Despite the association of ROP, oxygen use at 36-week-corrected age and late sepsis with hypothermia on bivariate analyses, in risk adjusted logistic regression models, hypothermia was not a significant risk factor, likely representing the confounding effect of factors such as birth weight.…”

“…[1][2][3][4][5] The World Health Organization (WHO) established criteria for assessing hypothermia and published a guidebook on the thermal protection of newborns in 1997, indicating that this issue is a worldwide problem even for term infants, particularly in developing nations. 6 WHO classifications of hypothermia are (1) cold stress or mild hypothermia: 36.0 to 36.4 1C (96.8 to 97.51 F); (2) moderate hypothermia: 32.0 to 35.9 1C (89.6 to 96.61 F); and (3) severe hypothermia: below 32 1C (<89.61 F).…”

Hypothermia and Related Factors in High-Risk Infants

“…This study demonstrated a dramatic effect of comorbidities and confirmed that hypothermia has a much worse outcome when associated with other newborn problems. Fatality rates increased to 71.4% with hypoglycemia, 83.3% with hypoxia, and 90.9% with shock [61].…”

The First Sixty Minutes in Preterm Neonates’ Life: Predicted Morbidities and Interventions

“…Moreover, hypothermia increases oxygen consumption, thus leading to hypoxia and subsequently pulmonary vasoconstriction which, in turn, declines surfactant production and worsens respiratory distress. The presence of comorbidities with hypothermia increases the fatality rate, so adding a higher category to the severity of hypothermia would represent an effective addition to the WHO classification of the severity of hypothermia [8].Large surface area of neonates in relation to their small body weight makes them more vulnerable to hypothermia than fullterm babies. Preterm neonates have a higher transepidermal water loss than term due to their immature epidermal layer [9].…”

“…Since the head constitutes a major portion of the body surface area in neonates and the brain plays the role of a prime heat-generating organ, head covering has been an effective technique in preventing temperature reduction in neonates [14]. But all these techniques are still insufficient in very preterm neonates.Ambient temperature of delivery room: According to WHO's recommendation the temperature of delivery rooms' should be adjusted at no less than 25°C, while the International Liaison Committee on Resuscitation (ILCOR) 2010 recommends that it should be ≥ 26 °C [3][4][5][6][7][8][9][10][11][12][13][14][15]. However, these suggestions aren't feasible targets.…”