Neonatal hypothermia and adherence to World Health Organisation thermal care guidelines among newborns at Moi Teaching and Referral Hospital, Kenya

Abstract

Neonatal hypothermia is a great concern with near epidemic levels globally. In Kenya, its prevalence is as high as 87% with limited local data on the associated factors such as adherence to warm chain guidelines as recommended by the World Health Organisation (WHO) is limited. This study aimed to determine the prevalence of hypothermia and level of adherence to the WHO thermal care guidelines among newborns admitted at Moi Teaching and Referral Hospital (MTRH). It adopted a prospective study design of following up neonates for the first 24 hours of admission to the MTRH newborn unit. Thermometry, interview of mothers and observation of thermal care practices was done. Descriptive and inferential statistical techniques were adopted. Specifically, Pearson’s chi-square test of associations between predictors of neonatal hypothermia and management outcomes was conducted with their corresponding risk estimates at 95% confidence interval. Among the 372 participants, 64.5% (n = 240) were born at MTRH, 47.6% (177) were preterm and 53.2% (198) had birth weights below 2500 grams. Admission hypothermia was noted among 73.7% (274) and 13% (49) died on the first day of admission. Only 7.8% (29) newborns accessed optimal thermal care. Prematurity, day one mortality and adherence to the warm chain were significantly (p<0.001) associated with admission hypothermia. Inappropriate thermal appliance, inadequate clothing and late breastfeeding significantly increased the risk of neonatal hypothermia. Absence of admission hypothermia increased the likelihood of neonatal survival more than twenty-fold (AOR = 20.91, 95% CI: 2.15–153.62). Three out four neonates enrolled had admission hypothermia which was significantly associated with prematurity, lack of adherence to warm chain and increased risk of neonatal mortality on the first day of life. There was low adherence to the WHO thermal care guidelines. This should be optimized among preterm neonates to improve likelihood of survival.

Admission Hypothermia and Factors Associated with Mortality among Admitted Hypothermic Preterm Neonates in Neonatal Intensive Care Units of Public Hospitals of Addis Ababa, Ethiopia

“…Furthermore, neonates who got kangaroo mother care had 62% less chance of dying than those who did not get the care. Even though our study had not considered the type of KMC provided, the finding is analogous to different studies [ 8 , 9 , 26 , 27 ]. Kangaroo care can help to stabilize heart rate, improve oxygen saturation and respiratory rate, improve infant lactation [ 28 ], and have positive effects on neurological, cognitive, emotional, behavioral, and social development in the short and long term [ 29 ].…”

Prevalence and Factors Associated with Hypothermia among Neonates in Regional Referral Hospitals in Dar es Salaam, Tanzania

“…The prevalence of hypothermia in this study was 25.6%, similar to the results in a study in Rwanda which assessed the prevalence and risk factors for neonatal hypothermia on admission into a tertiary neonatal unit (Choi, Urubuto, Dusabimana, Agaba, & Teteli., 2019). Several factors have been used to explain the differences in the prevalence of hypothermia between studies including methodologies, time at temperature measurements and socio-cultural factors (Nyandiko, Kiptoon, & Lubuya, 2021). In this study, axillary temperature measured within 90 minutes post-delivery was used to assess hypothermia post-delivery in a delivery room whose temperature ranged between 25 and 28 o C. The measurement method and the warm environment could explain the low prevalence of hypothermia compared 67.6% reported among neonates within 72 hours of hospitalisation (Ogunlesi, Ogunfowora, & Ogundeyi., 2009).…”

Factors associated with hypothermia within the first 6 hours of life in infants born at ≥340 weeks’ gestation: a multivariable analysis

“…Past studies have suggested a number of risk factors associated with hypothermia in neonates, including maternal hypertension, antenatal use of steroids, low maternal temperature, inadequate antenatal care, low birth weight, prematurity, need for resuscitation, nighttime delivery, delivery during cold season, low birth weight, and prematurity [ 1 , 6 , 9 – 14 ]. Warmer delivery room or resuscitation room temperatures and warm transport to NICU have been found to be protective against neonatal hypothermia [ 12 , 15 , 16 ].…”