Neonatal Hypothermia in Low-Resource Settings

doi:10.1053/j.semperi.2010.09.007

Seminars in Perinatology

Volume 34, Issue 6, December 2010, Pages 426-433

https://doi.org/10.1053/j.semperi.2010.09.007 Get rights and content

Hypothermia among newborns is considered an important contributor to neonatal morbidity and mortality in low-resource settings. However, in these settings only limited progress has been made towards understanding the risk of mortality after hypothermia, describing how this relationship is dependent on both the degree or severity of exposure and the gestational age and weight status of the baby, and implementing interventions to mitigate both exposure and the associated risk of poor outcomes. Given the centrality of averting neonatal mortality to achieving global milestones towards reductions in child mortality by 2015, recent years have seen substantial resources and efforts implemented to improve understanding of global epidemiology of neonatal health. In this article, a summary of the burden, consequences, and risk factors of neonatal hypothermia in low-resources settings is presented, with a particular focus on community-based data. Context-appropriate interventions for reducing hypothermia exposure and the role of these interventions in reducing global neonatal mortality burden are explored.

Section snippets

Thermal Regulation of the Newborn

Unlike poikilotherms whose body temperature can vary substantially with the external environment, humans are homeotherms and must generate heat to maintain a body temperature that varies only within a relatively small range (ie, normal variance of only 0.3%).⁷ During development, the core body temperature of the fetus is closely correlated with the mother, and as such, the core temperature of the fetus will normally remain a consistent and approximate 1°C above that of the mother. After birth,

Incidence of Neonatal Hypothermia in Low-Resource Settings

As a consequence of both the factors surrounding the immediate care of newborns and the risk these pose for heat loss, and the innate features of the neonate, it is of little surprise that hypothermia is a common phenomenon in low resources settings, including among infants born in facilities and in the community.

Consequences of Neonatal Hypothermia in Low-Resource Settings

A number of the hospital- and community-based studies described previously have also examined case-fatality rates (CFRs) between those babies with and without hypothermia, and concluded that the risk of mortality is higher among those exposed (Table 3). An analysis of 320 babies arriving at a tertiary care facility in Recife, Brazil indicated that moderate (32.0-35.9°C) hypothermia on admission was an independent risk factor for neonatal death (adjusted odds ratio = 3.49; 95% confidence

Risk Factors for Neonatal Hypothermia

To design effective strategies for reducing both the risk of hypothermia and the negative consequences, an improved understanding of factors that lead to hypothermia is required. Kumar et al¹⁵ provide a detailed discussion of possible risk factors for neonatal hypothermia, classifying these factors into contextual (eg, seasonality), physiological (eg, low birth weight), behavioral (eg, early bathing), and socioeconomic factors (eg, poverty). Behavioral factors appear to play a central role in

Interventions to Prevent Neonatal Hypothermia

Given the high incidence and serious consequences of hypothermia in low-resource settings and the limitations that these settings present in implementing standard warming techniques (including incubators) of greater-resource settings, the focus in low-resource facilities and communities is on behavioral practices. The WHO has provided guidelines for thermal care in low-resource settings and the 10-step warm chain described previously highlights specific practices that need to be promoted for

Conclusions

Newborn hypothermia remains one of the most important contributors to neonatal mortality and morbidity in both facilities and communities of low-resource settings. Recent data from the community in Nepal and India have expanded our understanding of the population-based burden in South Asia, and the hypothermia-mortality risk relationship is becoming increasingly clear. While no community-based data are available from sub-Saharan Africa, several current and future studies of interventions to

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