Background
The global burden of neonatal deaths and its relation to hypothermia
Methods
Results
The prevalence of neonatal hypothermia globally
Reference | Location | Setting | N | Case definition body temp | Temperature measurements | Hypothermia prevalence | Additional findings |
---|---|---|---|---|---|---|---|
Africa | |||||||
Hospital based: | |||||||
[28] | Sagamu, Nigeria | University Hospital | 150 | < 36.5°C | Axillary upon admission | 62% | Hypothermia risk highest in the first 24 h of life in preterm babies |
[75] | Sagamu, Nigeria | University Hospital | 111 | < 36.5°C | Axillary upon admission | 68% | Hypothermia risk highest in low birth weight babies and those who were not breastfed |
[76] | Ibadan, Nigeria | University Hospital | 541 | < 35.0°C | N/A | 45% | Hypothermia more prevalent on admission in infants born outside the hospital than those born at the hospital |
[35] | Guinea-Bissau | National Hospital | 2,926 | < 34.5°C | Axillary within 12 h of birth | 8% | Hypothermia of < 34.5°C associated with mortality risk of 4.81 (95% CI 2.90 to 8.00) in first 7 days compared to those without hypothermia |
[29] | Kampala, Uganda | Periurban Hospital | 300 | < 36.5°C | Rectal and tympanic four times within 90 minutes postpartum | 79% | Hypothermia incidence increased from 29% at 10 minutes postpartum to 79% at 90 minutes postpartum |
[47] | Kampala, Uganda | Periurban Hospital | 249 | < 36.5°C | Rectal 60 minutes postpartum | 46% | Early bathing increased the risk of hypothermia in spite of use of warm water and skin-to-skin care |
[25] | Lusaka, Zambia | University Hospital | 62 | < 36.0°C | Rectal 30 and 120 minutes after delivery | 53% and 69% | At discharge after an average of 14 h, hypothermia was still persistent in half of all babies sampled |
[26] | Lusaka, Zambia | University Hospital | 261 | < 36.0°C | Rectal upon admission | 44% | Mortality was higher in hypothermic infants than in those who were not hypothermic |
[77] | Harare, Zimbabwe | University Hospital | 313 | < 36.0°C | Axillary | 51.4% | |
[59] | Harare, Zimbabwe | University Hospital | 313 | < 36.0°C | Axillary upon admission | 85% | |
[27] | Ethiopia | Hospital | < 36.0°C | N/A | 53% | ||
Asia | |||||||
Hospital based: | |||||||
[78] | Iran, different provinces | University Hospitals | 1,952 | < 36.0°C | Rectal after delivery and four repeats within 6 h of admission to neonatal unit | 33.8% | Newborn with low birth weight, prematurity, low Apgar scores, of multiple pregnancies and after cardiopulmonary resuscitation at higher risk for being hypothermic in regression analysis. Hypothermia is associated with an increased risk of neonatal mortality risk (OR = 3.1, 95% CI 1.9 to 5.2) as well as risk of metabolic acidosis, jaundice, respiratory distress, hypoglycemia, and pulmonary hemorrhage. |
[33] | Tehran, Iran | University Hospitals | 940 | < 36.5°C | Rectal upon admission to neonatal unit (mean time after delivery 20 minutes) | 53.5% | Hypothermia at birth is associated with an increased neonatal mortality risk (OR = 3.64, 95% CI 1.85 to 7.18), as well as risk for respiratory distress (OR = 2.12, 95% CI 1.53 to 2.93), metabolic acidosis (OR = 2.83, 95% CI 1.74 to 4.59), and jaundice (OR = 2.01, 95% CI 1.45 to 2.79), controlling for weight and gestational age |
[32] | Tehran, Iran | University Hospital | 900 | < 36.5°C | Rectal after delivery and four repeats within 6 h of admission to neonatal unit | 53.3% | Low birth weight, low gestational, age environmental temperature, low Apgar score, multiple pregnancy and receiving cardiopulmonary resuscitation increased risk for being hypothermic in regression analysis |
[79] | Hangzhou, China | University Hospital | 200 | < 36.5°C | Axillary after delivery and five times on first, second and third day | 52% | Hypothermia risk associated with low birth weight and gestational age |
[40] | Kathmandu, Nepal | Maternity Hospital | 495 | < 36.0°C | Rectal 2 h after delivery | 85% | |
[80] | Kathmandu, Nepal | Maternity Hospital | 82 | < 35.0°C | Rectal after delivery | 26% | |
[60] | Kathmandu, Nepal | Maternity Hospital | 100 | < 36.0°C | Rectal after delivery | 64% | 16% of hypothermic infants died within first week of life |
[81] | Kathmandu, Nepal | Maternity Hospital | 76 | < 36.0°C | Axillary after delivery | 63% | |
[82] | Kathmandu, Nepal | Maternity Hospital | 35 | < 36.0°C | Continuous axillary and forehead skin probe | 72% (Incidence in percent of time being hypothermic from birth to 8 h of life) | |
[83] | Mumbai, India | Hospital | 206 | N/A | N/A | 37% | Prevalence 5.9% in infants with kangaroo mother care |
Asia | |||||||
Community based: | |||||||
[19] | Kathmandu, Nepal | Community | 12 | < 35.0°C | Rectal within 12 h after delivery | 91% | |
[84] | Kathmandu, Nepal | Community | 250 | < 36.0°C | Axillary | 82% | |
[20] | Haryana, India | Community | 189 | < 35.6°C | Axillary once on first day | 11% | Higher prevalence in winter (19%) than in summer (3%); in a secondary analysis applying a case definition of 36.5°C, prevalence was 38%; correlation between room air temperature and body temperature |
[21] | Gadchiroli | Community | 763 | < 35.0°C | Axillary on 8 days during first month | 17% | Higher prevalence in winter than in summer |
[22] | Uttar Pradesh, India | Community | 1,732 | < 36.5°C | Axillary 3 to 36 h after birth | 43% | Body temperature lower in low ambient temp < 20°C and in newborns with hypothermic mothers |
[85] | Dehli, India | Community | 32 | < 35.0°C | Axillary daily on first 7 days of life | 25% | |
[39] | Uttar Pradesh, India | Community | 148 | < 36.5°C | Axillary within 48 h and on days 7, 30 and 60 | 14% | |
[16] | Sarlahi, Nepal | Community | 23,240 | < 36.5°C | Axillary on 10 days during first month | 92.3% | Hypothermia risk highest in the first 72 h of life |
[17] | Sarlahi, Nepal | Community | 23,240 | < 36.5°C | Axillary on 10 days during first month | 92.3% | Hypothermia risk highest in preterm babies, females, those breastfed later than 24 h after delivery, and those with hypothermic mothers |
[18] | Sarlahi, Nepal | Community | 23,240 | < 36.5°C | Axillary on 10 days during first month | 92.3% | Mortality risk increases by 80% for every 1°C decrease. Mortality risk 6.11 for newborns < 35.0°C compared to those > 36.5°C. |
South America | |||||||
Hospital based: | |||||||
[34] | Recife, Brazil | University Hospital | 320 | < 36.5°C | Axillary on admission | 32% | Hypothermia increased neonatal mortality risk, AOR = 3.49, 95% CI 3.18 to 3.81 |