Neonatal hypothermia and adherence to world health organization thermal care guideline among newborns at Moi Teaching and Referral Hospital, Kenya

Abstract

Background: Neonatal hypothermia is a great concern with near epidemic levels globally. The prevalence in Kenya is as high as 87 %. Local data on the associated factors including adherence to warm chain guidelines as recommended by the World Health Organization (WHO) is limited. Objective: To determine the prevalence of neonatal hypothermia, associated factors and level of adherence to the WHO thermal care guidelines among newborns admitted at Moi Teaching and Referral Hospital (MTRH). Methods: This prospective cohort study was carried out among neonates admitted at MTRH between July and December 2016. Systematic sampling was used to recruit 372 eligible participants. Serial axillary thermometry, interview of respective mothers, observation of thermal care practices was done, and outcomes on the first day of admission determined. Means and medians described continuous variables while frequencies and corresponding percentages summarized categorical variables. Associations between the variables and neonatal hypothermia at admission were computed using the Pearson Chi-square and Fishers exact tests and the relative risks reported. Day one survival probability was assessed using the Kaplan Meier survival function with the outcome of time to event plotted on Kaplan Meier graphs. The log rank test was used to compare the survival distributions among neonates with or without hypothermia at admission. Results: Among the 372 participants enrolled, 240 (64.5%) were born at MTRH, 177 (47.6%) were preterm while 198 (53.2%) had birth weights less than 2500grams. Admission hypothermia (AH) was noted among 73.7% (n=274) while 13% (n=49) died on day one of admission. Only 7.8% (n=29) newborns accessed optimal thermal care. Prematurity, RR=1.62 (95% CI: 1.43-1.84) and suboptimal adherence to the warm chain (P<0.001) significantly increased the risk of admission hypothermia specifically inappropriate thermal resuscitation appliance, RR=1.50 (95% CI: 1.34- 1.67), inappropriate clothing, RR = 1.78 (95% CI: 1.54 - 2.05) and late breastfeeding, RR = 2.01 (95% CI: 1.39-2.89). There was significantly poor day one survival probability among newborns with admission hypothermia with early onset of adverse events,(mortality) compared to their none hypothermic counterparts, (P<0.001 ). Conclusion: Three out of four neonates at the MTRH newborn unit had hypothermia at admission which was significantly associated with prematurity and adherence to warm chain. Early onset of adverse outcomes, (mortality) with poor day one survival probability was noted among the newborns presenting with hypothermia at admission. Recommendation: Optimize adherence to the warm chain and a follow up study to determine the factors associated with the sub-optimal thermal care noted at MTRH. Priority triage and an anticipatory approach to thermal care of the preterm and lower birth weight neonate is also key.