Main Article Content
Background. Neonatal hypothermia, defined as a body temperature <36.5°C, is a known contributor to neonatal morbidity and mortality. The admission temperature is an important predictor of neonatal outcomes, and a measure of quality of care.
Objectives. This study aims to determine the incidence of and factors associated with hypothermia on admission to the neonatal unit at Steve Biko Academic Hospital (SBAH), a public tertiary hospital in South Africa.
Methods. A retrospective, cross-sectional study of infants admitted to the neonatal unit from September 2019 to February 2020 using data from patient records.
Results. The overall incidence of hypothermia on admission was 66% (mild 25%, moderate to severe 41%), with a mean (standard deviation (SD)) admission temperature of 35.1 (4.7)°C, and 82% (mild 19%, moderate to severe 62%) in very-low-birthweight infants. Infants remained hypothermic for a mean (SD) of 4.1 (3.9) hours post admission. Birthweight ≤1 500 g (odds ratio (OR) 1.87; p=0.019), admission to the neonatal intensive care unit (OR 1.97; p<0.0001), and admission from the delivery room within the first 60 minutes of life (OR 3.06; p=0.026) were independent risk factors for hypothermia. Hypothermia was associated with increased duration of respiratory support (mean 3.2 (5.6) v. 1.7 (4.5) days; p<0.0001), and longer length of hospital stay (mean 17.9 (18.8) v. 10.9 (12.6) days; p<0.0001).
Conclusion. The incidence of hypothermia on admission to the unit is significantly high, and hypothermic infants take a significant length of time to regain normothermia. A standardised protocol for the prevention and management of hypothermia needs to be introduced in the unit.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJCH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
World Health Organization, Maternal and Newborn Health/Safe Motherhood Unit. Thermal Protection of the Newborn : A Practical Guide. Geneva: Maternal and Newborn Health/Safe Motherhood Unit, Division of Reproductive Health (Technical Support), WHO, 1997.
Vermont Oxford Network. Despite decreases, nearly 4 in 10 infants are cold when admitted to the NICU. NICU by the Numbers, 19/9/2017. https://public. vtoxford.org/nicu-by-the-numbers/despite-decreases-nearly-4-in-10-infants- are-cold-when-admitted-to-the-nicu/ (accessed 20 September 2017).
Carlo WA. Perinatal and neonatal care in developing countries. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant, 11th ed. Philadelphia: Mosby/ Elsevier, 2020:120-139.
Mullany LC, ed. Neonatal hypothermia in low-resource settings. Semin Perinatol 2010;34(6):426-433. https://doi.org/10.1053/j.semperi.2010.09.007
Madar J, Roehr CC, Ainsworth S, et al. European Resuscitation Council
Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation 2021;161:291-326. https://doi.org/10.1016/j. resuscitation.2021.02.014
Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13: Neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132(18 suppl 2):S543-S60. https://doi.org/10.1161/CIR.00000000000002677.
Laptook AR, Salhab W, Bhaskar B. Admission temperature of low birth weight infants: Predictors and associated morbidities. Pediatrics 2007;119(3):e643-e649. https://doi.org/10.1542/peds.2006-0943
Da Mota Silveira SM, de Mello MJG, de Arruda Vidal S, de Frias PG, Cattaneo A. Hypothermia on admission: A risk factor for death in newborns referred to the Pernambuco Institute of Mother and Child Health. J Trop Pediatrics 2003;49(2):115-120. https://doi.org/10.1093/tropej/49.2.115
McCall EM, Alderdice F, Halliday HL, Vohra S, Johnston L. Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2018;2(2):CD004210. https://doi.org/10.1002/14651858. CD004210.pub5.
Bissinger RL, Annibale DJ. Thermoregulation in very low-birth-weight infants during the golden hour: Results and implications. Adv Neonatal Care 2010;10(5):230-238. https://doi.org/10.1097/ANC.0b013e3181f0ae63
Mullany LC, Katz J, Khatry SK, LeClerq SC, Darmstadt GL, Tielsch JM. Risk of mortality associated with neonatal hypothermia in southern Nepal. Arch Pediatr Adolesc Med 2010;164(7):650-656. https://doi.org/10.1001/ archpediatrics.2010.103
Wilson E, Maier RF, Norman M, et al. Admission hypothermia in very preterm infants and neonatal mortality and morbidity. J Pediatr 2016;175:61-67.e4. https://doi.org/10.1016/j.jpeds.2016.04.01613.
Lunze K, Hamer D. Thermal protection of the newborn in resource-limited environments. J Perinatol 2012;32(5):317-324. https://doi.org/10.1038/jp.2012.11 14. Tshehla RM, Coetzee M, Becker PJ. Mortality and morbidity of very low- birthweight and extremely low-birthweight infants in a tertiary hospital in Tshwane. S Afr J Child Health 2019;13(2):89-97. https://doi.org/10.7196/
Lunze K, Bloom DE, Jamison DT, Hamer DH. The global burden of neonatal hypothermia: Systematic review of a major challenge for newborn survival. BMC Med 2013;11(1):1-11. https://doi.org/10.1186/1741-7015-11-24
Ogunlesi TA, Ogunfowora OB, Adekanmbi FA, Fetuga BM, Olanrewaju DM. Point-of-admission hypothermia among high-risk Nigerian newborns. BMC Pediatr 2008;8(1):1-5. https://doi.org/10.1186/1471-2431-8-40
UkkeGG,DiribaK.Prevalenceandfactorsassociatedwithneonatalhypothermia on admission to neonatal intensive care units in Southwest Ethiopia: A cross- sectional study. PloS ONE 2019;14(6):e0218020. https://doi.org/10.1371/journal. pone.0218020
Ng’eny JC, Velaphi S. Hypothermia among neonates admitted to the neonatal unit at a tertiary hospital in South Africa. J Perinatol 2020;40(3):433-438. https://doi.org/10.1038/s41372-019-0539-y
Asakura H. Fetal and neonatal thermoregulation. J Nippon Med School 2004;71(6):360-70. https://doi.org/10.1272/jnms.71.360
Ågren J. Thermal environment of the intensive care nursery. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 11th ed. Philadelphia: Mosby/Elsevier, 2020: 566-576.
Onalo R. Neonatal hypothermia in sub-Saharan Africa: A review. Nigerian J Clin Prac 2013;16(2):129-138. https://doi.org/10.4103/1119-3077.110120
Oatley H, Blencowe H, Lawn J. The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates. J Perinatol 2016;36(1):S83-S89. https://doi.org/10.1038/jp.2016.35
Pinheiro JM, Furdon SA, Boynton S, Dugan R, Reu-Donlon C, Jensen S. Decreasing hypothermia during delivery room stabilisation of preterm neonates. Pediatrics 2014;133(1):218-226. https://doi.org/10.1542/peds.2013-1293