Validation of a Novel Technique that Minimises Early Neonatal Deaths - a Comparative Study

Abstract

Nigeria did not achieve the millennium development goal (MDG) for the reduction of under-5 mortality (U5M) in 2015. Neonatal death still accounts for nearly 50% of U5M, hence responsible for this failure. The World Health Organisation records showed that 79% of deceased neonates would die within the first-seven-days (F7D) of life in Nigeria. Prolonged postnatal delay before attainment of normal body temperature could be partly responsible. Reducing F7D deaths could improve Nigeria's overall record; hence the urgent need to device a technique that could be applied to achieve this. We developed a neonatal temperature control protocol "the initial-setpoint-algorithm (ISA)" as a response to temperature-related high F7D mortality rate. A total 134 cases (105 controls and 29 tests) were recruited. The cases drew from extremely-low birth weight and preterm neonates (BW = 600-1200 g, GA = 26-32 weeks) presenting at the University of Abuja Teaching Hospital Nigeria. Mortality outcomes were compared to investigate how the ISA group performed relative to the Control group. Applying ISA, Test-patients attained normotherm in 0.47 hr post-presenting (95%CI: 0.2); Control took 12.4 hrs (95%CI: 2.3). The F7D-deaths contribution to mortality in the control group was 71% (41 out of 58). There was no F7D death amongst the only two deceased neonates in the test group. The ISA helped quick attainment of normotherm in the Test-group; hence removed the immediate postnatal long exposure to damaging thermal shock that trailed other neonates to death within the F7D period.

Reducing Early Neonatal Mortality in Nigeria—The Solution

“…The search began with a nationally circulated questionnaire that identified lack of functional incubators as a major factor militating against neonatal survival in Nigeria [17]. However, advancing consistently with various careful comparative investigations, our research can presently reveal a strong association of "thermoneutral instability", hiding behind a host of co-morbid conditions that had been said to be responsible for high rate of neonatal mortality in Nigeria [15]. Consistent thermal stability within body temperatures of 36.5-37.4°C is essential for the neonate's physiological wellness to fight disabling conditions, maintain positive progress, and for survival.…”

“…(a) Neonatal deaths accounting for nearly 50% of all deaths of children under 5 years of age [1,15] (b) Nearly 80% of all deceased neonates dying within their first 1 week of life [14,16] …”

“…This targets a quick attainment of normotherm at the onset of incubator intervention (Figure 4). This effectively removes the often long postnatal exposure of neonates to temperatures outside the safezone, as this has been argued to inflict a lasting damage that trails some of them to death within their first week of life [15]. The ISA was such a powerful tool that might have coincidentally led to the reduction of F7D contribution to mortality, from 71 to 0%, in a set of studied neonatal cohorts at the University of Abuja Teaching Hospital Nigeria [15].…”

“…This effectively removes the often long postnatal exposure of neonates to temperatures outside the safezone, as this has been argued to inflict a lasting damage that trails some of them to death within their first week of life [15]. The ISA was such a powerful tool that might have coincidentally led to the reduction of F7D contribution to mortality, from 71 to 0%, in a set of studied neonatal cohorts at the University of Abuja Teaching Hospital Nigeria [15]. The devastating postnatal thermal shock described in the research was widespread across Nigerian centers and explained the reason behind the WHO figure of 79% for the mortalities happening before the seventh postnatal day; this figure has never changed between the 2008 and 2013 demographic survey reports [14].…”

“…ISA application enabled clinicians at our center to achieve neonatal normotherm in an average of 28 min as compared to conventional average outcome of 12 h and 24 min. The thermal devastation of almost 12½ h long in a hostile environment is unbearable for the poor neonates, especially the preterms, as they are coming from the well-regulated comforts of the womb [15]. Thus, the ISA has been demonstrated to be an effective tool for the care of preterm neonates and a dependable response to this problem.…”