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Hypothermia in the Newborn: An exploration of its cause, effect and prevention



According to the World Health Organization (WHO, 1997) a newborn is normothermic when its body temperature is between 36.5°C and 37.5°C with hypothermia considered to be any temperature below this identified spectrum. Neonatal hypothermia is a potentially common and dangerous occurrence related to a number of risk factors categorised as environmental, physiological, behavioural and socioeconomic. Babies delivered by caesarean section are at particular risk of developing hypothermia. The purpose of this review is to provide an overview of the factors contributing to neonatal hypothermia including the physiology of thermoregulation, mechanisms of thermogenesis and heat loss, and the effects that neonatal hypothermia has on the newborn infant. The paper will also review the interventions, which may be adopted to prevent hypothermia occurring and to identify and intervene to reduce the impact of hypothermia including the effect of skin-to-skin contact as both a preventative and management strategy in neonatal hypothermia.
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© 2014 MA Healthcare Ltd
Hypothermia in the newborn—an
exploration of its cause, effect and
Hypothermia is considered to be a
major contributing factor to neonatal
morbidity and, in extreme cases,
mortality (Kumar et al, 2009). Newborns are at risk
of hypothermia irrespective of their nationality,
sex and gestation. Modern technology, advanced
medical techniques and evidence-based practice
contribute to reduced rates of neonatal morbidity
and mortality in resource rich countries. Educated
and trained health professionals decrease the
risk of hypothermia in the newborn, while the
development of professional guidelines promote a
safer and more accurate management of neonatal
hypothermia and its effects (Knobel et al, 2005;
Chomba et al, 2008; Kumar et al, 2009; Sobel et
al, 2010).
Physiology of thermoregulation
Every human, regardless of age, has the ability to
maintain a core body temperature within a specific
range in order to preserve good body function.
Humans are homeotherms by nature; they produce
their own temperature and maintain it within
normal levels by balancing their heat loss and heat
production according to their needs (Gardner et al,
2011). This ability of balancing body temperature is
defined as thermoregulation. In contrast, difficulty
in maintaining this balance is characterised as
ineffective thermoregulation (Carpenito-Moyet,
2008). Newborn babies have a greater difficulty
maintaining their body temperature than adults
and children. This is seen most frequently and at
the highest degree in premature babies (Kumar
et al, 2009; Gardner et al, 2011). Preterm infants
have a greater need for an environment with
a neutral temperature due to their ineffective
thermoregulation (Lunze and Hamer, 2012). Once
born, the baby is exposed to an atmospheric
temperature (about 25°C)—significantly below
intrauterine temperature (approximately 37°C).
This ‘colder’ environment, in combination with
the newborn’s wet body, results in a heat-loss of
between 0.1°C to 0.3°C per minute and of up to
of 0.2°C to 1°C per minute (were no precautions
taken regarding neonatal thermal protection after
birth) (Waldron and MacKinnon, 2007; Kumar et
al, 2009). This cold-shock stimulates the newborn
to commence two main physiological mechanisms
in order to produce heat and to maintain its
temperature at normal levels (Kumar et al, 2009).
Extrauterine thermogenesis
The first mechanism allows the newborn to
activate non-shivering thermogenesis in order
to produce heat by using brown adipose tissue
(BAT). The second mechanism is peripheral
vasoconstriction whereby the blood vessels located
peripherally in the newborn’s body constrict in
an attempt to prevent further heat loss (Polin et
al, 2011). While Hillman et al (2012), Lunze and
Hamer (2012), and Polin et al (2011) suggest that
shivering thermogenesis can occur in newborn
babies, they consider it to be of ‘secondary
importance’ and to rarely occur. Regardless of the
type of thermogenetic mechanism, it is known
that preterm or low birth weight babies have a
significantly higher risk of poor thermoregulation
and increased heat-loss, due to their reduced body
According to the World Health Organisation (WHO, 1997) a newborn
is normothermic when its body temperature is between 36.5°C and
37.5°C with hypothermia considered to be any temperature below this
identified spectrum. Neonatal hypothermia is a potentially common and
dangerous occurrence related to a number of risk factors categorised
as environmental, physiological, behavioural and socioeconomic. Babies
delivered by caesarean section are at particular risk of developing
hypothermia. The purpose of this review is to provide an overview of the
factors contributing to neonatal hypothermia including the physiology
of thermoregulation, mechanisms of thermogenesis and heat loss, and
the effects that neonatal hypothermia has on the newborn infant. The
paper will also review the interventions, which may be adopted to prevent
hypothermia occurring and to identify and intervene to reduce the impact
of hypothermia including the effect of skin-to-skin contact as both a
preventative and management strategy in neonatal hypothermia.
Keywords: Neonatal hypothermia, thermoregulation, thermogenesis,
heat loss mechanisms, skin-to-skin contact
Aliona Vilinsky
Rotunda Hospital
Ann Sheridan
UCD School of Nursing
Midwifery & Health
Health Sciences Centre
University College
396 British Journal of Midwifery August 2014 Vol 22, No 8
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as to a standard accepted normal temperature
range with different values identified in different
studies (Kumar et al, 2009).
The lack of an agreed normal temperature value
results in range of temperatures being accepted as
‘normal’ by various authors with neonatal norms
ranging between 36 and 37.7°C, depending on
the geographical location of the study as well
as the environmental/seasonal conditions (Lunze
et al, 2013). In the absence of agreement among
researchers, WHO guidelines are used to describe
the ‘normal’ ranges of neonatal normothermia and
WHO (1997) considers a newborn to be
normothermic when temperature is between 36.5
and 37.5°C and hypothermic, when temperature
is below the spectrum mentioned above. In order
to facilitate the diagnosis and management of
hypothermia, WHO has divided this classification
into three well defined categories.
These categories are (WHO, 1997):
lMild hypothermia: with ranges between 36
and 36.4°C
lModerate hypothermia: ranging between 32
and 35.9°C
lSevere hypothermia: with any temperature
below 32°C.
While the WHO categories are useful, it does
not identify the body site associated with each
temperature category and this presents further
challenges with the potential to result in a degree
of confusion for both researchers and health
professionals. Rectal temperature is approximately
0.5–1°C higher than oral and/or axillar temperature
and is generally considered more representative of
the core temperature (Ganong, 2005). However,
given the risks associated with the measurement
of rectal temperature in newborn babies (i.e. rectal
perforation and nosocomial infections), it is not
recommended for newborn infants (Hertz, 2005).
WHO recommend that neonatal temperature is
measured at the axilla and recommends that rectal
temperatures are only measured in the event of
diagnosed neonatal hypothermia. While the above
classification is used by some maternity hospitals
internationally, its use is still narrowly spread.
Kumar et al (2009) identified that of 20 studies
reviewed, only seven used the WHO classification
system. This inconsistency of classifying neonatal
hypothermia may lead to under-recognition as
well as inadequate management of newborn
hypothermia (Kumar et al, 2009). It is essential,
therefore, that guidelines are developed for the
classification, prevention and management
strategies for neonatal hypothermia, and that they
are implementated by all medical, nursing and
fat storages, thinner skin, and increased body
surface compared to body mass (Waldron and
MacKinnon, 2007).
Neonatal heat-loss mechanisms
There are four basic mechanisms that cause heat
loss from the newborn; evaporation, radiation,
conduction, and convection (World Health
Organization (WHO), 1997; Waldron and
MacKinnon, 2007; Blackburn, 2008; Soll, 2008;
Kumar et al, 2009; Davis, 2009). These mechanisms
may cause heat-loss regardless of the type of birth,
gestation or birth environment, and awareness
of their effects by health professionals is critical
for the prevention and management of neonatal
Evaporation occurs when the amniotic fluid
covering the newborn and the mucosa of the
respiratory tract of the baby, vaporise following
birth (Davis, 2009; Blackburn, 2008). Radiation
occurs when heat is lost from the baby to any surface
surrounding it that is not directly connected to it,
including walls or any surfaces close to the baby
which are colder than the baby (Davis, 2009).
Radiation can also positively affect the
temperature of a newborn with heat being gained
from sources that radiate heat, such as heat lamps
(Soll, 2008). Like radiation, conduction can result
in both heat-loss, when the warm, naked body of
the baby is placed on a colder surface; and heat-
gain when a baby is placed on a warmer surface,
for example on its mother’s chest during skin-to-
skin contact (Lunze and Hamer, 2012; Gouchon
et al, 2010; Galligan, 2006; WHO, 1997; Durand et
al, 1997)
Convection refers to the heat-loss from the
baby’s body through the surrounding air (Kumar
et al, 2009). This heat-loss can occur in either a
passive or forced way. Passive convection happens
when heat escapes from the skin surface of the
baby. Forced convection occurs when an air current
passes over the baby’s body, removing the heat in a
faster and more aggressive way (Blackburn, 2008).
The ability of a baby to create (thermogenesis) and
regulate its body temperature (thermoregulation)
are not always sufficient to enable the maintainence
temperature within the accepted ‘normal’ range. If
not prevented and/or managed, temperature loss
in a newborn will result in neonatal hypothermia
with serious and potentially fatal consequences.
Neonatal hypothermia
Neonatal hypothermia is a pathological condition
where the temperature of the newborn drops below
the recommended normal temperature ranges.
However, no agreement exists within the literature
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vasoconstriction, acrocyanosis, cold extremities)
(Waldron and MacKinnon, 2007; Onalo, 2013).
Disturbance associated with the baby’s metabolism
can also result in symptoms of hypoglycaemia,
hypoxia and eventually metabolic acidosis (Waldron
and MacKinnon, 2007; Freer and Lyon, 2011). Failure
to diagnose and manage hypothermia may lead
to chronic symptoms such as weight loss and/
or slow weight gain, with the eventual outcome
of negatively impeding normal growth and
development (UNICEF, 2004). Other complications
associated with hypothermia are severe sepsis and
neonatal death (WHO, 1997; Mullany, 2010; Lunze
and Hammer, 2012; Onalo, 2013).
Prevention and management of
neonatal hypothermia
There is a substantial body of literature suggesting
methods for preventing neonatal hypothermia
both for term and pre-term infants, whether born
in high or low resource countries (Soll, 2008;
Holtzclaw, 2008; WHO, 1997; Knobel et al, 2005).
The majority of the literature describes how to
prevent hypothermia by focusing on improving
environmental factors. In particular there is
agreement that the birth room temperature is
required to be a minimum of 25°C for term babies
and 26–28°C for pre-term babies (WHO, 1997;
Knobel et al, 2005). Soll (2008) suggests that
delivery rooms tend to be kept at a temperature,
while pleasant for health professionals and
mothers, does not adequately consider the needs of
newborn babies. Raising awareness among health
professionals about the effects of a cold room on
newborns and the requirement to maintain room
temperature above 25 or 26°C, is a simple yet critical
intervention to help prevent neonatal hypothermia.
The development and implementation of protocols
and education seminars to promote awareness and
enhance evidence-based knowledge is essential
in all birth environments (Nirmala et al, 2006;
Chomba et al, 2008; Kumar et al, 2009; Sobel
et al, 2010). However, maintaining a high room
temperature alone is insufficient, as prevention
of hypothermia due to environmental factors also
includes techniques of passive and active warming
(Holtzclaw, 2008).
Passive warming includes all man-made tools
that act as barriers to heat loss. The literature
identifies two fundamental heat loss barrier tools;
polyurethane caps and plastic bag wraps. The
majority of these studies have examined the effects
these tools have in the prevention of hypothermia
in pre-term babies (Roberts, 1981; Trevisanuto et
al 2010; Khairina et al, 2011; Gathwala et al, 2010;
Leadford et al, 2013). Active warming, refers to the
midwifery staff in each hospital.
Risk factors for neonatal
Neonatal hypothermia is related to a number
of risk factors, which are categorised by Lunze
et al (2013) into four main groups. These are:
environmental, physiological, behavioural and
socioeconomic. Environmental risk factors are
related to the geographical area in which the baby
is born, as well as time of the year (seasons) and
room temperature at the time of birth (Lunze et
al, 2013; WHO, 1997). While the prevalence of
neonatal hypothermia is higher during the winter
season, being born during the summer months or
in a warm tropical climate, does not automatically
eliminate the risk of a baby becoming hypothermic
and highlights the need for continued vigilance
to prevent, identify and manage neonatal
Physiological risk factors mainly pertain to
neonatal issues such as prematurity, low birth
weight and intrauterine growth restriction. Babies
who are ‘small for dates’ or hypoglycaemic are also
at increased risk for hypothermia (Kumar et al,
2009; Gardner et al, 2011; Lunze et al, 2013).
Behavioural risk factors are considered to be
any non-evidence based practices, sometimes
undertaken for cultural reasons, which may
potentially cause a reduction in the baby’s
temperature resulting in hypothermia. Two
examples of such practices are: bathing of the
newborn immediately after birth, and/or
massaging the baby with essential oils after birth
(Bergstrom et al, 2005; Onalo, 2013).
Socioeconomic factors can also contribute to
neonatal hypothermia. Socially mothers who are
either young and inexperienced, or multiparas
who are minding many children; babies born in
families with a low income and/or from resource
poor countries are also more likely to be socially and
economically disadvantaged. Health professionals
in resource poor countries may not have access
to knowledge and/or best available evidence or
other resources to support best practice, therefore
babies born in these countries may also be at risk
of neonatal hypothermia (Lunze et al, 2013).
Effects of hypothermia on the
Hypothermia in a newborn is detected through
a number of objective signs resulting from the
impact on multiple body systems; cardiopulmonary
(bradycardia, tachypnea, apnoea); the central
nervous system (lethargy, distress, poor
feeding), and the vascular system (peripheral
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methods used to warm the baby in a direct way.
Two active warming methods identified in the
literature including radiant heaters and skin-to-
skin contact (Holtzclaw, 2008). Radiant warmers
and exothermic mattresses are used either during
the resuscitation of the newborn or to warm up a
cold baby. The first device spreads heat through
radiation while the second group of devices heats
the baby through conduction. Skin-to-skin contact
is an alternative and natural way of active warming
and one that has benefits for both baby and
Skin-to-skin contact
Skin-to-skin contact or Kangaroo care (KC) is a
well-explored practice over the past 25 years (Flynn
and Leahy-Warren, 2010; Lunze et al, 2013) whereby
the newborn is positioned in an upright position,
between its mother’s breasts, wearing only a nappy
and a hat (Nirmala et al, 2006; Gabriel et al, 2009;
Takahashi et al, 2011). This approach has been
recommended for its ability to maintain the baby’s
temperature within normal parameters (Carfoot et
al, 2005; Hunt, 2008; Gouchon et al, 2010; Gabriel
et al, 2011), and to warm up babies with mild
hypothermia (WHO, 1997). Among the recognised
benefits of skin-to-skin contact is its ability to
promote early initiation of breastfeeding and to
prolong its duration (UNICEF, 2004; Carfoot et al,
2005; Hunt, 2008; Bramson et al, 2010; Gouchon et
al, 2010; Gabriel et al, 2011; Suzuki, 2013; Svensson
et al, 2013) skin-to-skin contact also improves
the heart rate and oxygen saturation levels of the
baby (Nirmala et al, 2006; Hunt, 2008; Nolan and
Lawrence, 2009; Takahashi et al, 2011) and allows
earlier brain maturity in premature infants in
comparison with premature infants who had no
skin-to-skin contact (Kaffashi et al, 2013).
The majority of the research examining skin-
to-skin contact involves babies born vaginally
with only two papers focusing on full-term
babies temperatures born after caesarean section
(Gouchon et al, 2010; Nolan and Lawrence, 2009).
The first study was an experimental trial in which 34
mother and baby pairs were randomly selected and
separated into two groups (skin-to-skin contact
group and routine care (RC) group) after elective
caesarean section. The babies’ temperatures were
checked with an infra-red thermometer half
hourly for 2 hours post-birth and the mother’s
temperature was measured prior to and following
the surgical procedure and while holding their
babies. The findings demonstrated that babies
who had skin-to-skin contact were not at risk of
hypothermia when compared to the routine care
baby group (Gouchon et al, 2010). However, a careful
examination of the documented temperatures of
babies and mothers in this study indicates that, in
fact, the documented temperatures were indicative
of mild-to-moderate hypothermia (as defined
by WHO (1997)). Furthermore, some practices
used in this study are not recommended for
application by WHO. Examples include: bathing
babies after birth, delivery room temperatures
less than 25°C (mean of 22°C), and skin-to-skin
contact was not always commenced after birth.
. As a result difficulties exist with this study in
demonstrating that skin-to-skin contact following
caesarean section maintain neonatal temperature
within the range defined as normal by WHO
(1997). Furthermore, any connection between low
maternal temperatures with the prevalence of
hypothermia in infants is not explored.
Nolan and Lawrence (2009) reviewed a sample
of 50 mother–baby pairs which were separated
evenly into a skin-to-skin contact group and a RC
group. Infants’ temperatures were obtained from
medical record at 0.5, 1 and 2 hours post-birth;
however, 30% of temperatures were missing. This
study demonstrated that babies in the skin-to-skin
contact group had higher mean temperatures than
the RC-group babies, although this temperature
difference was not statistically significant. Maternal
temperature and delivery room temperature were
not included in this study thus no association
can be made between maternal temperature and
that of the baby during skin-to-skin contact. The
authors of both articles suggest further research is
required to investigate this subject fully (Gouchon
et al, 2010; Nolan and Lawrence, 2009). Given
that caesarean section rates have almost doubled
since the previous WHO report in 1985, there is
also a significant lack of evidence supporting the
benefits of skin-to-skin contact in preventing/
managing neonatal hypothermia following
caesarean section, therefore further research is
required taking into consideration these new
circumstances (WHO, 2010).
Neonatal hypothermia is a major risk factor
to neonatal morbidity and, in extreme cases,
mortality (Kumar et al, 2009). Newborns are at risk
of hypothermia irrespective of their nationality, sex
and gestation. Unlike adults and children, newborn
infants have greater difficulty maintaining their
body temperature.
Neonatal hypothermia is a condition that has
potentially life threatening effects for the newborn
infants worldwide. A significant challenge in
research and practice pertaining to neonatal
hypothermia is the absence of an agreed and
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internationally accepted definition of neonatal
normothermia and hypothermia. The failure
to have an agreed standard for temperature in
neonates results in continuing confusion about
how hypothermia is defined, when it should be
diagnosed and when intervention are required
to mitigate its deleterious effects. Agreement
is also required relating to site of temperature
measurement and type of thermometer used.
Therefore a suggestion emanating from this review
is that in the absence of an agreed definition
of neonatal normothermia and hypothermia,
future research should adopt the existing
WHO classification and categorisation. Doing
so will ensure greater consistency in terms of
measurement and interpretation of research
results and their translation into practice.
Preventing hypothermia by focusing on
improving environmental factors has been
identified as a simple and achievable yet critical
intervention. Further management includes
maintaining delivery room temperature between a
minimum of 25°C for term babies and 26–28°C for
pre-term babies as well as ensuring that all health
professionals are aware of and intervene to ensure
adequate temperature is maintained is required.
One of the suggested practices to prevent and or
treat mild hypothermia in newborn infants is skin-
to-skin contact. However, the available research
regarding skin-to-skin contact and hypothermia
in infants post caesarean section is limited.
Furthermore, the connection between maternal
hypothermia, skin-to-skin contact and neonatal
hypothermia after caesarean section has not been
explored in any depth and needs to be examined
(Horns et al, 2002; Fallis et al, 2006; Yokoyama et
al, 2008; Nolan and Lawrence, 2009; Gouchon et
al, 2010). Cold adversely impacts the health and
wellbeing of newborn infants and understanding
its causes and how to prevent it is an essential part
of the midwife and doctor’s role around the time
of birth. It is imperative that we understand the
process and what steps can be taken to prevent
hypothermia and in doing so, provide a safe and
secure environment into which a baby can be born.
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Key points
lThe newborn uses mainly non-shivering thermoregulation in order to
produce heat and to maintain its temperature at normal levels
lThere are four basic mechanisms that cause heat loss from the
newborn; evaporation, radiation, conduction and convection
lThe World Health Organization has divided hypothermia into three well
defined categories: mild, moderate and severe hypothermia
lRisk factors for neonatal hypothermia are divided into: environmental,
physiological, behavioural and socioeconomic risk factors
lPrevention and management of neonatal hypothermia include two
main categories: passive and active warming
lSkin-to-skin contact is the most effective method of active warming
for babies born after vaginal delivery. Further research is needed for
babies born by caesarean section
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... recommended normal temperature range, which is a body temperature of less than 36.5°C to 37.5°C (WHO in Vilinsky and Sheridan, 2014). ...
... Suhu tubuh diatur oleh sistem saraf otonom dan hipotalamus.Pengaturan suhu tubuh (termoregulasi) merupakan kemampuan untuk menyeimbangkan produksi panas (heat production) dan kehilangan panas (heat loss) untuk menjaga suhu tubuh normal. Hipotermia neonatus adalah suatu kondisi patologisdimana suhu bayi baru lahir turundi bawah kisaran suhu normal yang direkomendasikan (Vilinsky & Sheridan, 2014). ...
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Introduction: Bathing of neonate is a part of the birth process by cleaning the baby's body, watering or soaking. However, neonates may experience heat loss more rapidly and show signs of vital instability. Objectives: The purpose of this study was to compare the stability of the vital signs of neonates who immediately took a bath and who delayed bathing. Methods: the research method as a comprehensive search strategy, namely articles in the database of research journals through the Scopus database, Proquest, Clinical Key, and Science Direct with full text criteria and published in years. 2016-2020. Results: The results obtained in this study indicate that it is advisable to delayed bathing in newborns so that the stability of vital signs is better
... Newborns are susceptible to hypothermia (temperature < 97.7°F) due to their large surface area to body weight ratio, reduced glycogen and fat stores, immaturity of compensatory mechanisms and environmental factors that promote heat loss [1]. Upon exposure to a hypothermia-inducing stressor in the infant, compensatory mechanisms increase the metabolic rate to maintain normothermia. ...
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Baby-Friendly hospitals encourage rooming-in newborns with mothers. In our institution, we noticed increased incidence of hypothermia following Baby-Friendly designation. We aimed to reduce the incidence of hypothermia in the mother-baby-unit to <15% and to decrease the rate of isolated hypothermia admissions to the neonatal intensive care unit (NICU) by 20% over two years. After a retrospective review of newborns ≥35 weeks gestation in the mother-baby-unit with hypothermia, we implemented multiple interventions such as nursing education, hypothermia algorithm, Kamishibai cards, and Key cards. Hypothermia incidence in the mother-baby-unit decreased from 20.9 to 14.5% (p < 0.001) and infants requiring NICU admission decreased by 71% (p < 0.001) following all interventions. Apart from nursing education, all interventions led to significant reductions in both outcomes from baseline. Instituting a hypothermia algorithm and utilizing K-cards and Key cards reduces the incidence of hypothermia in the mother-baby-unit and NICU admissions for isolated hypothermia.
... and severe hypothermia (<32˚C) with the severity scale carrying prognostic implications [3]. Neonatal hypothermia has been associated with a number of risks factors such as physiological and behavioural characteristics of the neonate and caregivers as well external factors such as the environmental conditions [4]. In Spain, hypothermia was associated with very low birth weight (VLBW) among infants [5]. ...
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Neonatal hypothermia is a great concern with near epidemic levels globally. In Kenya, its prevalence is as high as 87% with limited local data on the associated factors such as adherence to warm chain guidelines as recommended by the World Health Organisation (WHO) is limited. This study aimed to determine the prevalence of hypothermia and level of adherence to the WHO thermal care guidelines among newborns admitted at Moi Teaching and Referral Hospital (MTRH). It adopted a prospective study design of following up neonates for the first 24 hours of admission to the MTRH newborn unit. Thermometry, interview of mothers and observation of thermal care practices was done. Descriptive and inferential statistical techniques were adopted. Specifically, Pearson’s chi-square test of associations between predictors of neonatal hypothermia and management outcomes was conducted with their corresponding risk estimates at 95% confidence interval. Among the 372 participants, 64.5% (n = 240) were born at MTRH, 47.6% (177) were preterm and 53.2% (198) had birth weights below 2500 grams. Admission hypothermia was noted among 73.7% (274) and 13% (49) died on the first day of admission. Only 7.8% (29) newborns accessed optimal thermal care. Prematurity, day one mortality and adherence to the warm chain were significantly (p<0.001) associated with admission hypothermia. Inappropriate thermal appliance, inadequate clothing and late breastfeeding significantly increased the risk of neonatal hypothermia. Absence of admission hypothermia increased the likelihood of neonatal survival more than twenty-fold (AOR = 20.91, 95% CI: 2.15–153.62). Three out four neonates enrolled had admission hypothermia which was significantly associated with prematurity, lack of adherence to warm chain and increased risk of neonatal mortality on the first day of life. There was low adherence to the WHO thermal care guidelines. This should be optimized among preterm neonates to improve likelihood of survival.
... The development of professional guidelines promotes a safer and more accurate management of neonatal hypothermia and its effects [1][2][3][4]. Temperature drop in a newborn will result in neonatal hypothermia with serious and potentially fatal consequences if not prevented or managed appropriately [5]. ...
Background Evidence is lacking regarding the optimal method of rewarming hypothermic low-birth-weight (LBW) pre-term neonates. We aim to evaluate the effect of rapid vs. slow rewarming in the management of moderate to severe hypothermia in LBW pre-term neonates. Methods In this open label, randomized controlled trial, 100 LBW (<2.5 kg), pre-term (<37 weeks) neonates with moderate to severe hypothermia (<36°C) was randomized to two groups of 50 each and received either rapid (at >0.5°C/h) or slow (at ≤0.5°C/h) rewarming rate till normothermia. The primary outcome was stabilization score [TOPS (temperature, oxygenation, perfusion and saturation) and MSNS (modified sick neonatal score)] at baseline, 6 and 24 h and mortality until discharge. Other neonatal morbidities were assessed as secondary outcomes. Results Mean TOPS score and MSNS score at baseline, 6 and 24 h of admission as well as change in score from baseline were similar between the two groups. The median rewarming rate [interquartile range (IQR)] was higher in rapid rewarming group than in the slow rewarming group [5.05°C/h (3.54–7.71) vs. 0.71°C/h (0.60–0.90); p < 0.001]. The median rewarming time taken in rapid rewarming group was lesser compared with that in the slow rewarming group [0.31 h (IQR 0.13–0.75) vs. 2.05 h (IQR 1.11–3.03); p < 0.001]. Mortality in rapid rewarming and slow rewarming group was similar [7/50 vs. 5/50; OR 1.46 (0.43–4.97), p = 0.538] Conclusion Rapid rewarming was as effective and safe as slow rewarming in the management of moderate to severe hypothermia in LBW pre-term neonates with similar short-term neonatal outcomes. CTRI number CTRI/2018/01/011187.
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Kalça kırıkları özellikle ileri yaştaki hastalarda mortalite ve morbiditeye neden olduğundan önemli bir halk sağlığı sorunu oluşturmaktadır (1). Gelecekteki kalça kırığı hastalarının sayısının tahmin edilmesi, sağlık ve sosyal hizmetler üzerindeki artan yüke, özellikle de dünyada eşi benzeri görülmemiş hızlı artışların görüleceği bölgelerde mümkün olduğunca hazırlıklı olmak için gereklidir. Osteoporotik kalça kırıkları tipik olarak yaşlı popülasyonda meydana gelir ve düşük enerjili travmalardan (örneğin basit düşme) kaynaklanır. Birleşik Krallık Ulusal Kalça Kırığı Veri Tabanı’ndan yayınlanan en son rapor, kalça kırıklarının %91,6'sının 70 yaşın üzerindeki hastalarda meydana geldiğini ve çoğunluğunun (%72) kadın olduğunu ortaya koymaktadır (2). Bu dağılım, düşme olasılığının artmasını yansıtmaktadır. 65 yaş üstü üç kişi her yıl düşer, ve ilerleyen yaşla birlikte osteoporoz olur (3). Kalça kırığı geçirenlerde sıklıkla önemli komorbiditeler örnektir (4). Hasta genellikle kalça ağrısı ve ağırlık verememe ile başvurur. Etkilenen bacak kısaltılabilir ve dışa doğru döndürülebilir.
Thermoregulation is an essential component to the stability and long-term outcomes of newborns and critically-ill neonates. A thermoneutral environment (TNE) is an environment in which a neonate maintains a normal body temperature while minimizing energy expenditure and oxygen consumption. Neonates who experience thermal stability within a TNE demonstrate enhanced growth, decreased respiratory support, decreased oxygen requirements, increased glucose stability, reduced mortality, and reduced morbidities associated with hyperthermia and hypothermia. Heat exchange occurs between the neonate and surrounding environment through four mechanisms: evaporation, conduction, convection, and radiation. By recognizing the methods by which heat is lost or gained, the neonatal provider can prevent adverse conditions related to abnormal thermal control and support a thermoneutral neonatal environment.
Background Neonatal hypothermia is a major risk factor for morbidity and mortality of neonates in the first 28 days since birth. However, few studies have investigated the occurrence of neonatal hypothermia in preterm newborns in southwest Ethiopia. This study aimed to determine the prevalence of and factors associated with neonatal hypothermia in preterm neonates admitted to a neonatal intensive care unit (NICU) in Southwest Ethiopia. Methods An institutional based prospective cross-sectional study was conducted in preterm infants admitted to the NICU at Bench Sheko, Kafa, and Sheka hospitals between March and September 2020, using systematic sampling technique. Binary logistic regression analysis was used to assess the association between neonatal hypothermia and explanatory variables. The strength of association was evaluated using an odds ratio at a 95% confidence interval, where statistical significance was considered at a threshold of p < 0.05. Results The prevalence of neonatal hypothermia was 62.9% (95%CI: 58.4%–67.6%). Neonatal hypothermia was associated with their having been an antenatal care visit (AOR: 0.52; 95%CI: 0.29-0.94), obstetric complication during delivery (AOR: 4.7; 95%CI: 1.78–12.34), caesarian section delivery (AOR: 1.91; 95%CI: 0.740–4.96), non-vertex presentation (AOR: 2.59; 95%CI: 1.06–6.32), 5-min APGAR score <7 (AOR: 2.19; 95%CI: 1.148–4.17), practicing kangaroo mother care (AOR: 55; 95%CI: 0.340-0.893), and the initiation of breastfeeding between 1 and 2 h (AOR: 2.39; 95%CI: 1.29–4.415). Conclusion The prevalence of neonatal hypothermia was high. Nearly two-thirds of neonates admitted to NICU in southwest Ethiopia had neonatal hypothermia. Healthcare professionals working in the delivery room and/or NICU must be made aware of factors associated with neonatal hypothermia to ensure the early detection and appropriate management of the condition and thus to improve outcomes in infants presenting with neonatal hypothermia.
Background: Providing authentic educational experiences in clinical teaching laboratories or health care simulation environments is fundamental to producing optimum learning. However, some simulated diagnostic devices are price prohibitive or yet to be developed. This article explores a collaborative effort between health academics and engineering interns to develop cost-effective, authentic devices that overcome limitations of those currently available. Method: Simulated patient tympanic thermometer and pulse oximetry devices were developed for use in clinical teaching laboratories and health care simulation environments. Results: The tympanic thermometers and pulse oximetry probes provide programmable temperature, pulse, and oxygen saturation for use with any commercially available manikins or standardized patients. Conclusion: Authentic simulated diagnostic devices can enhance reality and foster immersion in clinical simulation scenarios. Sharing cost-effective innovations designed to address the simulation-specific limitations of commercially available diagnostic devices provides health care educators with solutions that can enhance the authenticity of clinical teaching experiences for participants. [J Nurs Educ. 2021;60(4):235-239.].
Skin-to-skin contact (SSC) is commonly performed after normal vaginal delivery and there is an increased demand by mothers to perform SSC after caesarean section (CS). However, there are still many obstacles that inhibit the initiation of SSC after CS, especially the risk of neonatal hypothermia. Although the evidence suggests that SSC promotes neonatal normothermia, this evidence is based on studies after vaginal birth and not after CS. Current literature suggests that both mothers and newborns may become hypothermic during or after a CS in the absence of active preventative measures. Suboptimal neonatal and maternal temperatures could have adverse physiological effects in both newborns and mothers. This narrative review predominantly focuses on the available evidence for SSC after CS. It also synopsises the adverse effects of hypothermia in neonates and mothers, and explains the physiology of peripartum thermoregulation, the mechanisms of heat loss and their prevention.
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Background and objectives: Hypothermia contributes to neonatal mortality and morbidity, especially in preterm and low birth weight infants in developing countries. Plastic bags covering the trunk and extremities of very low birth weight infants reduces hypothermia. This technique has not been studied in larger infants or in many resource-limited settings. The objective was to determine if placing preterm and low birth weight infants inside a plastic bag at birth maintains normothermia. Methods: Infants at 26 to 36 weeks' gestational age and/or with a birth weight of 1000 to 2500 g born at the University Teaching Hospital in Lusaka, Zambia, were randomized by using a 1:1 allocation and parallel design to standard thermoregulation (blanket or radiant warmer) care or to standard thermoregulation care plus placement inside a plastic bag at birth. The primary outcome measure was axillary temperature in the World Health Organization-defined normal range (36.5-37.5°C) at 1 hour after birth. Results: A total of 104 infants were randomized. At 1 hour after birth, infants randomized to plastic bag (n = 49) were more likely to have a temperature in the normal range as compared with infants in the standard thermoregulation care group (n = 55; 59.2% vs 32.7%; relative risk 1.81; 95% confidence interval 1.16-2.81; P = .007). The temperature at 1 hour after birth in the infants randomized to plastic bag was 36.5 ± 0.5°C compared with 36.1 ± 0.6°C in standard care infants (P < .001). Hyperthermia (>38.0°C) did not occur in any infant. Conclusions: Placement of preterm/low birth weight infants inside a plastic bag at birth compared with standard thermoregulation care reduced hypothermia without resulting in hyperthermia, and is a low-cost, low-technology tool for resource-limited settings.
We tested the hypothesis that 15 min of forced-air prewarming, combined with intraoperative warming, prevents hypothermia and shivering in patients undergoing elective cesarean delivery. We simultaneously tested the hypothesis that maintaining maternal normothermia increases newborn temperature, umbilical vein pH, and Apgar scores. Thirty patients undergoing elective cesarean delivery were randomly assigned to forced-air warming or to passive insulation. Warming started 15 min before the induction of epidural anesthesia. Core temperature was measured at the tympanic membrane, and shivering was graded by visual inspection. Patients evaluated their thermal sensation with visual analog scales. Rectal temperature and umbilical pH were measured in the infants after birth. Results were compared with unpaired, two-tailed Student’s t-tests and χ² tests. Core temperatures after 2 h of anesthesia were greater in the actively warmed (37.1°C ± 0.4°C) than in the unwarmed (36.0°C ± 0.5°C;P < 0.01) patients. Shivering was observed in 2 of 15 warmed and 9 of 15 unwarmed mothers (P < 0.05). Babies of warmed mothers had significantly greater core temperatures (37.1°C ± 0.5°C vs 36.2°C ± 0.6°C) and umbilical vein pH (7.32 ± 0.07 vs 7.24 ± 0.07).
We examined the effect of early skin-to-skin contact (SSC) on breast-feeding at 1 month after delivery, in Japanese women. We reviewed the obstetric records of healthy nulliparous women with vaginal singleton delivery at 37-41 weeks' gestation, at the Japanese Red Cross Katsushika Maternity Hospital and between 1 February and 30 November 2011, there was a total of 403 women who planned to breast-feed their babies at birth. Of these, 272 women (67.5%) initiated early SSC in the delivery room and 131 women (32.5%) did not initiate early SSC. There were no significant differences in the obstetric characteristics and birth outcomes between the two groups of women with and without initiating early SSC. However, the rate of exclusive breast-feeding at 1 month after delivery in the group of women following early SSC (59.6%, 162/272) was significantly higher than that in the group of women without early SSC (45.8%, 60/131; crude OR 1.74, 95% CI 1.1-2.7, p = 0.009). The current results may support the benefit of early SSC in Japanese women after vaginal delivery.
The importance of keeping the newborn baby warm has been known for centuries but worldwide in the 21st century hypothermia remains a major contributor to neonatal mortality. Although less of a problem in high income countries there is evidence that low temperatures have an impact on outcome at vulnerable times, particularly in the baby born preterm. It is clear that if we are to see further improvements in mortality and morbidity in the most immature babies there must be careful attention given to all aspects of basic neonatal care, including thermoregulation. Continuous dual temperature monitoring has advantages over intermittent measurements and is the method of choice in the immature and sick newborn. There is no evidence of any differences in outcome between radiant heaters or incubators. Whichever device is used fluid and heat loss from evaporation due to high transepidermal water loss remains a problem. This is best managed by increasing environmental humidity but the optimum level of added humidity, and the length of time that this should be applied, is still unknown.
Kangaroo care is a method of caring for newborn infants, and has benefits that include stabilisation of cardio-respiratory system, thermoregulation and a higher incidence of exclusive breastfeeding. Skin-to-skin contact has an important role both for the sick infant and its parents because of the positive implications on the growth and development of the preterm infant. Specifically KC can improve infants oxygen saturation and significantly reduce their oxygen requirements during the contact time. Physical contact between preterm infants and parents is often very delayed. KC allows this contact sooner than normal and improves parental confidence in caring for their infant. Research shows that KC is safe and beneficial however time, space and lack of protocol inhibit regular use of KC in neonatal units.
The burden evoked as a result of low birth weight in developing countries is a major public health problem. High mortality rates amongst this group of high-risk neonates could be reduced by the provision of quality health care. But with limited resources available and booming costs of the high technology care required for LBW neonates, it is essential to test alternative approaches that could reduce the induced separation of mother and baby, and which would be sustainable for its cost, acceptability and ease in implementation. Hence with this intention in mind, Kangaroo Mother Care (KMC) was tested on low birth weight (LBW) babies of a selected tertiary hospital for its effect on the physiological parameters (heart rate, respiratory rate, temperature and oxygen saturation). Perceptions regarding KMC of mothers as well as health personnel were assessed. The repeated measure design was used. A non-probability purposive sample of 50 stable LBW babies between 29 and 41 weeks gestation and weighing 1070–2460g was recruited for the study. Physiological parameters were observed in four sets for each neonate, with each set consisting of observation just before initiating KMC, half an hour after initiating KMC, just before discontinuing KMC and half an hour after its discontinuation and one set being observed per day. No significant changes were observed in all the physiological parameters during KMC and routine care. Perceptions of mothers and health personnel were positive towards KMC. This method is feasible, with limited infrastructure and equipment required for its implementation.
Aim: To investigate Irish neonatal nurses' knowledge and beliefs of Kangaroo care. Background: Although kangaroo care existed in other countries for 25 years, it is a new occurrence in Irish neonatal care. A review of the literature suggests that, while it demonstrates benefits for both infants and parents, some neonatal nurses do not exhibit an awareness of current kangaroo care research, or hold positive beliefs towards its use with preterm infants. As they have the most parent-infant contact and influence over whether kangaroo care is carried out, their knowledge and beliefs are of importance. Method: A quantitative, descriptive design with neonatal nurses (n = 62) was used. Findings: Fifty six neonatal nurses (90.3%) believed kangaroo care a safe alternative for stable growing preterm infants, agreeing on the benefits for both infants and parents The overall level of neonatal nurses' knowledge of kangaroo care varied from good to excellent, the lowest score being 35/51. Results indicated nurses' uncertainty regarding kangaroo care with intubated infants, and infants requiring blood pressure support, umbilical lines and phototherapy. This suggests the need to provide education on kangaroo care to foster the development of more positive beliefs and increase staff knowledge of potential adverse effects.