Hypothermia of newborns is associated with excess mortality in the first 2 months of life in Guinea‐Bissau, West Africa

Abstract

Summaryobjective To examine the long-term effects of neonatal hypothermia (HT) on survival. methods Using the longitudinal community and hospital surveillance system of the Bandim Health Project, we followed children born between 1997 and 2002 at the only maternity ward in the city. All children's axillary temperature was measured within 12 h of birth. They were followed from birth to 6 months of life through regular home visits.results We identified 2926 live births in the study area and 177 deaths before 6 months of age. Based on mortality risk, we defined a temperature below 34.5°C as the cut-off point for HT. Two hundred and thirty-eight (8%) children had HT. Controlled for birth weight, HT was associated with a nearly fivefold increase in mortality during the first 7 days of life [mortality ratio (MR) = 4.81 (2.90-8.00)] and with increased mortality from 8 to 56 days of life [MR = 2.55 (1.29-5.04)].conclusion HT is associated with excess mortality beyond the perinatal period up to at least 2 months of age, especially among low-birth-weight children. Hence, failure to comply with the WHO guidelines for care of newborns in low-income countries may have long-term consequences for child survival which have not previously been assessed. The WHO definition of HT should be based on mortality data.

Randomized Trial of Plastic Bags to Prevent Term Neonatal Hypothermia in a Resource-Poor Setting

“…1 Compared with the developed world, neonatal mortality in the developing world is 6 times higher. 2 Hypothermia, in particular, is associated with increased neonatal mortality, 3,4 and each 1°C decrease in axillary temperature is associated with a 75% increase in neonatal mortality. 5 Hypothermia in newborns occurs in all climates, and the highest risk is within the first minutes to hours after birth as the newborn adjusts to the extrauterine environment.…”

Plastic Bags for Prevention of Hypothermia in Preterm and Low Birth Weight Infants

“…2 Hypothermia has long been recognized as a serious risk to newborns, especially premature and low birth weight infants, [3][4][5][6] and is a problem in both the developed 7 and the developing world. 1,[8][9][10] Neonatal hypothermia has been associated with increased risk of infection, coagulation defects, acidosis, delayed fetal-to-newborn circulatory adjustment, hyaline membrane disease, brain hemorrhage, increased oxygen consumption, and increased mortality. 3,5,[11][12][13] Infants are most at risk for hypothermia in the first few minutes to hours after birth, when they are first removed from the thermally regulated intrauterine environment.…”

“…5,12,14 Hypothermia can occur in infants of all countries, including tropical climates. 8,9,15,16 The World Health Organization (WHO) recommendations to prevent hypothermia include a warm delivery room (25°C), immediate drying, and resuscitation under radiant warmers, skin-to-skin contact with the mother, or an incubator. 17 Low-cost technologies used to prevent hypothermia in preterm and very low birth weight infants in the developed world could be extended to the developing world.…”

Hypothermia and Related Factors in High-Risk Infants

“…Overall, the prevalence of hypothermia in hospital-based studies ranges from 32 to 85%, with the exception of a low outlier (8% in Guinea Bissau [35]). This wide range might in part be attributable to the varying case definition of hypothermia across studies, ranging from 35.0°C to 36.5°C, and in part to the climatic environment and its seasonal variations discussed below.…”