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      Neonatal Hypothermia and Associated Risk Factors at Baby Friendly Hospital in Babol, Iran

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          Abstract

          Background:

          Thermal care is an important element of Baby Friendly Hospital.

          Aim:

          The objective of this study was to determine the prevalence of neonatal hypothermia and associated risk factors in healthy full term newborns at a Baby Friendly Hospital.

          Subjects and Methods:

          A cross-sectional, descriptive study was conducted on consecutively healthy full term neonates recruited during a 1 year. Temperatures were recorded immediately after birth and at the age of 1, 2 and 4 h after birth in order to estimate the prevalence of neonatal hypothermia, defined as axillary temperature less than 36.0°C. The data were collected using an especially questionnaire; data of history of abortion, parity, mode of vaginal delivery, gestational age, birth weight, newborn temperatures, time of the first skin-to-skin contact, time of first breast feeding, first wrapping and first visiting by the pediatrician. Association between neonatal hypothermia and risk factors was determined using logistic regression.

          Results:

          Axillary temperature showed 41.2%, 47.5%, 46.4% and 37.2% of the a consecutive number of 522 healthy full term neonates were moderately hypothermia immediately after birth, at 1 h, 2 h and 4 h respectively. Spontaneous labor and warming room were associated with decreased risk of hypothermia. A persistently high prevalence of neonatal hypothermia was shown within the first 4 h of vaginal birth. All analyses were carried out using the SPSS version 17.0 (Chicago IL, USA). Test of the associations were done, stepwise multiple logistic regressions. Odds ratios (ORs) were assessed using maximum likelihood and associated 95% confidence intervals were computed. A P ≤ 0.05 was considered to be statistically significant

          Conclusion:

          The findings of this study indicated that a high prevalence of neonatal hypothermia was identified among healthy full term newborn in a Baby Friendly Hospital Initiative. Therefore, it is necessary to emphasize on the development “warm chain” in preventing neonatal hypothermia in Baby Friendly Hospital.

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          Most cited references20

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          The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival

          Karsten Lunze, David Bloom, Dean T Jamison … (2013)
          Background To provide evidence on the global epidemiological situation of neonatal hypothermia and to provide recommendations for future policy and research directions. Methods Using PubMed as our principal electronic reference library, we searched studies for prevalence and risk factor data on neonatal hypothermia in resource-limited environments globally. Studies specifying study location, setting (hospital or community based), sample size, case definition of body temperature for hypothermia, temperature measurement method, and point estimates for hypothermia prevalence were eligible for inclusion. Results Hypothermia is common in infants born at hospitals (prevalence range, 32% to 85%) and homes (prevalence range, 11% to 92%), even in tropical environments. The lack of thermal protection is still an underappreciated major challenge for newborn survival in developing countries. Although hypothermia is rarely a direct cause of death, it contributes to a substantial proportion of neonatal mortality globally, mostly as a comorbidity of severe neonatal infections, preterm birth, and asphyxia. Thresholds for the definition of hypothermia vary, and data on its prevalence in neonates is scarce, particularly on a community level in Africa. Conclusions A standardized approach to the collection and analysis of hypothermia data in existing newborn programs and studies is needed to inform policy and program planners on optimal thermal protection interventions. Thermoprotective behavior changes such as skin-to-skin care or the use of appropriate devices have not yet been scaled up globally. The introduction of simple hypothermia prevention messages and interventions into evidence-based, cost-effective packages for maternal and newborn care has promising potential to decrease the heavy global burden of newborn deaths attributable to severe infections, prematurity, and asphyxia. Because preventing and treating newborn hypothermia in health institutions and communities is relatively easy, addressing this widespread challenge might play a substantial role in reaching Millennium Development Goal 4, a reduction of child mortality.
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            Neonatal hypothermia in low resource settings: a review.

            V. Kumar, J. C. Shearer, A. Kumar … (2009)
            Hypothermia is increasingly recognized as a major cause of neonatal morbidity and mortality in resource poor settings. High prevalence of hypothermia has been reported widely from warmer high mortality regions of Africa and South Asia. The World Health Organization recognizes newborn thermal care as a critical and essential component of essential newborn care; however, hypothermia continues to remain under-documented, under-recognized and under-managed. This review aims to provide a thorough patho-physio-epidemiological discussion of neonatal hypothermia applied to local risk factors within the developing country context with particular emphasis on prevention, recognition and management. All available published literature on neonatal hypothermia relevant to resource poor settings were reviewed. Studies from the developing country settings were primarily reviewed for epidemiology, domiciliary risk factors as well as potential interventions for thermal care. Functional integrity and efficiency of biological systems is critically dependent on an optimal and very narrow range of core body temperature. Risk factors for neonatal hypothermia differ markedly within low resource settings. A combination of physiological, behavioral and environmental factors universally put all newborns, irrespective of birth weight, at risk of hypothermia. The knowledge deficit along the continuum from health providers to primary care givers has sustained the silent epidemic of hypothermia. The challenges of recognition, understanding of local risk factors and communication have meant a lack of informed thermal care for newborns. Simple, feasible interventions exist, but need to be applied, based on local risk factors that disrupt the warm chain. Further research is needed to document local risk factors, develop better techniques for recognition, evaluation of thermal care within essential newborn care and communication strategies for program effectiveness.
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              Neonatal hypothermia and associated risk factors among newborns of southern Nepal

              Luke C. Mullany, Joanne Katz, Subarna Khatry … (2010)
              Background Neonatal hypothermia is associated with an increased mortality risk for 28 days. There are few community-based data on specific risk factors for neonatal hypothermia. Estimates of association between neonatal hypothermia in the community and risk factors are needed to guide the design of interventions to reduce exposure. Methods A cohort of 23,240 babies in rural southern Nepal was visited at home by field workers who measured axillary temperatures for 28 days (213,316 temperature measurements). The cumulative incidence of hypothermia (defined as 2500 g). Risk varied inversely along the entire weight spectrum: for every 100 g decrement hypothermia risk increased by 7.4%, 13.5% and 31.3%% for babies between 3000 g and 2500 g, 2500 g and 2000 g and < 2000 g, respectively. Preterm babies (< 34 weeks), females, those who had been first breastfed after 24 h and those with hypothermic mothers were at an increased risk. In the hot season the risk disparity between smaller and larger babies increased. Hypothermia was not associated with delayed bathing, hat wearing, room warming or skin-to-skin contact: they may have been practiced reactively and thereby obscured any potential benefit. Conclusions In addition to season in which the babies were born, weight is an important risk factor for hypothermia. Smaller babies are at higher relative risk of hypothermia during the warm period and do not receive the protective seasonal benefit apparent among larger babies. The need for year-round thermal care, early breastfeeding and maternal thermal care should be emphasized. Further work is needed to quantify the benefits of other simple neonatal thermal care practices.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Med Health Sci Res
                Journal ID (iso-abbrev): Ann Med Health Sci Res
                Journal ID (publisher-id): AMHSR
                Title: Annals of Medical and Health Sciences Research
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2141-9248
                ISSN (Electronic): 2277-9205
                Publication date (Print): Jul-Aug 2014
                Volume: 4
                Issue: Suppl 2
                Pages: S99-S103
                Affiliations
                [1] Fatemezahra Infertility and Reproductive Health Research Center, Department of Midwifery, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
                [1 ] Non-Communicable Pediatric Disease Research Center, Department of Pediatrics, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
                [2 ] Student Research Committee, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
                Author notes
                Address for correspondence: Dr. Mouloud Agajani Delavar, Department of Midwifery, Babol University of Medical Sciences, Ganjafroz 2247136 Babol, Islamic Republic of Iran E-mail: moloodaghajani@ 123456yahoo.com
                Article
                Publisher ID: AMHSR-4-99
                DOI: 10.4103/2141-9248.138022
                PMC ID: 4145526
                PubMed ID: 25184096
                SO-VID: 00426467-bcf2-4273-9c12-355fddb1c0e8
                Copyright © Copyright: © Annals of Medical and Health Sciences Research
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Categories
                Subject: Original Article

                ScienceOpen disciplines: Medicine
                Keywords: baby-friendly,hospital,hypothermia,ira,newborn
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: baby-friendly, hospital, hypothermia, ira, newborn

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