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.