Prevalence, immediate outcome and factors associated with early onset hypothermia in neonatals admitted to the Special Care Unit, Mulago hospital.
Twesigye, Catherine Nyangabyaki
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Hypothermia has been recognised as an independent risk factor for death in neonates for the last 40 years, regardless of the gestational age and weight. It is common in developing countries affecting more than half of all newborns in many communities and is associated with an increased risk of mortality. The admission incidence of hypothermia was 77% in neonates admitted to the special care unit at mulago hospital with a mean axillary temperature of 35.4oc. We undertook a study to establish the prevalence, immediate outcome and factors associated with early onset hypothermia in neonates admitted to the special care unit, mulago hospital in Uganda. METHODS: Between December 2008 and February 2009, we consecutively recruited 294 neonates in the SCU, Mulago hospital to determine the prevalence and factors associated with early onset hypothermia. Two hundred and fifty-six (256) of these babies were followed up in the ratio of 3:1 of hypothermic to normothermic babies respectively to describe their immediate outcome. Data was entered using Epi-data version 3:1 and analyzed using SPSS version 11. Cross tabulations and p-values were done for baseline characteristics, neonatal clinical features and outcome. Logistic regression was carried out to determine factors independently associated with early onset hypothermia. RESULTS: The prevalence of hypothermia among the neonates admitted to the SCU was 67%. The majority had moderate hypothermia. Prematurity was significantly associated with early onset hypothermia. Initiation of breast feeding before admission, presence of convulsions or jaundice and absence of cyanosis were negatively associated with hypothermia. The majority in the first 7 days of admission in the SCU was high in both hypothermic and normothermic neonates (19% and 16% respectively), hypothermia was not significantly associated with mortality, but admission age age>_ 1hour, respiratory distress and convulsions were significantly associated with mortality. CONCLUSION: Hypothermia is highly prevalent in the SCU in Mulago hospital. Early initiation of breast feeding in the term neonates might reduce the number of babies admitted to the SCU with hypothermia. Thermal protection of both the preterm and term neotates (undergoing resuscitation in the labour suite) is important in order to reduce morbidity and mortality in this group. RECOMMENDATIONS: Establishment of the warm chain, with a warm resuscitation surface in the labour suites and skin-to-skin (for ambulant mothers) or plastic wraps (covering the baby from the neck down to the feet) to transport babies from the labour suites to the SCU would reduce hypothermia in these neonates. Antenatal care should be strengthened to routinely screen and manage all mothers for treatable illnesses such as malaria, urinary tract infections, syphilis and anaemia in order to avoid preterm labour and delivery. Other studies are recommended in order to discover other factors contributing to the high mortality rate in order that they might be addressed.