Prevalence, immediate outcome and factors associated with early onset Hypothermia in neonates admitted to the Special Care Unit, Mulago Hospital

Abstract

Hypothermia has been recognized 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 35.40C. 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 of hypothermia. We followed up 256 of these babies in the ratio of 3:1 of hypothermic to normothermic babies respectively, for associated factors and 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 breastfeeding before admission, presence of convulsions or jaundice and absence of cyanosis were negatively associated with hypothermia. The mortality 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. Conclusion Hypothermia is highly prevalent in the SCU in Mulago hospital. Early initiation of breastfeeding in the term neonates might reduce the number of babies admitted to the SCU with hypothermia. Thermal protection of both the preterm and term neonate (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 or plastic bags to transport babies from the labour suites to the SCU would reduce hypothermia in these neonates.