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Kozuki N, Katz J, LeClerq SC, Khatry SK, West KP, Christian P. Risk factors and neonatal/infant mortality risk of small-for-gestational-age and preterm birth in rural Nepal. J Matern Fetal Neonatal Med 2014; 28:1019-25. [PMID: 25000447 DOI: 10.3109/14767058.2014.941799] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Our study seeks to elucidate risk factors for and mortality consequences of small-for-gestational-age (SGA) and preterm birth in rural Nepal. In contrast with previous literature, we distinguish the epidemiology of SGA and preterm birth from each other. METHODS We analyzed data from a maternal micronutrient supplementation trial in rural Nepal (n = 4130). We estimated adjusted risk ratios (aRR) for risk factors of SGA and preterm birth, and aRRs for the associations between SGA/preterm birth and neonatal/infant mortality. We used mutually exclusive categories of term-appropriate-for-gestational-age (AGA), term-SGA, preterm-AGA, and preterm-SGA (with term-AGA as reference) in our analyses. RESULTS Stunted (<145 cm) and wasted (<18.5 kg/m(2)) women both had increased risk of having term-SGA (aRR 1.36, 95% CI: 1.14-1.61, aRR 1.22, 95% CI: 1.09-1.36 respectively) and preterm-SGA (aRR 2.48, 95% CI: 1.29-4.74, aRR 1.99, 95% CI: 1.33-2.97 respectively), but not preterm-AGA births. Similar results were found for low maternal weight gain per gestational week. Those born preterm-SGA generally experienced the highest neonatal and infant mortality risk, although term-SGA and preterm-AGA newborns also had statistically significantly high mortality risks compared to term-AGA babies. CONCLUSIONS SGA and preterm birth have distinct risk factors and mortality patterns. Maternal chronic and acute malnutrition appear to be associated with SGA outcomes. Because of high SGA prevalence in South Asia and the increased neonatal and infant mortality risk associated with SGA, there is an urgent need to intervene with effective interventions.
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Horn EP, Bein B, Steinfath M, Ramaker K, Buchloh B, Höcker J. The incidence and prevention of hypothermia in newborn bonding after cesarean delivery: a randomized controlled trial. Anesth Analg 2014; 118:997-1002. [PMID: 24681658 DOI: 10.1213/ane.0000000000000160] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Little is known about thermoregulation of the newborn while bonding on the mother's chest immediately after cesarean delivery. Newborn hypothermia is associated with serious complications and should be avoided. Therefore, we evaluated whether newborns develop hypothermia during intraoperative bonding while positioned on their mothers' chests and investigated the effects of active cutaneous warming of the mothers and babies during a 20-minute intraoperative bonding period. METHODS We enrolled 40 parturients scheduled for elective cesarean delivery under spinal anesthesia. Mothers and their newborns were randomized to receive either passive insulation or forced-air skin-surface warming during the surgical procedure and bonding period. The primary outcome was neonatal core temperature at the end of the bonding period. Core temperatures of the newborns were measured with a rectal probe. Body temperatures of the mothers were assessed by sublingual measurements. Skin temperatures, thermal comfort of the mothers, and perioperative shivering were evaluated. RESULTS Without active warming from the beginning of the surgical procedure until the end of the bonding period, the mean (SD) neonatal core temperature decreased to 35.9 (0.6)°C. Seventeen of 21 (81%) newborns became hypothermic (defined as a core temperature below 36.5°C). Active skin-surface warming from the beginning of the surgical procedure until the end of the bonding period resulted in a neonatal core temperature of 37.0 (0.2)°C and a decreased incidence of hypothermia (1 of 19 (5%) newborns (P < 0.0001)). In addition, active warming increased the mean skin temperatures of the infants, maternal core and skin temperatures, maternal thermal comfort, and reduced perioperative shivering. CONCLUSIONS Active forced-air warming of mothers and newborns immediately after cesarean delivery reduces the incidence of infant and maternal hypothermia and maternal shivering, and increases maternal comfort.
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Affiliation(s)
- Ernst-Peter Horn
- From the *Departments of Anesthesiology and Intensive Care Medicine, Regio Klinikum Pinneberg, Pinneberg, Germany; †Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; and ‡Department of Gynecology and Obstetrics, Regio Klinikum Pinneberg, Pinneberg, Germany
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Trevisanuto D, Satariano I, Doglioni N, Criscoli G, Cavallin F, Gizzi C, Martano C, Ciralli F, Torielli F, Villani PE, Di Fabio S, Quartulli L, Giannini L. Delivery room management of extremely low birthweight infants shows marked geographical variations in Italy. Acta Paediatr 2014; 103:605-11. [PMID: 24606020 DOI: 10.1111/apa.12612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/06/2014] [Accepted: 02/20/2014] [Indexed: 01/21/2023]
Abstract
AIM To evaluate any geographical variations in practice and adherence to international guidelines for early delivery room management of extremely low birthweight (ELBW) infants in the North, Centre and South of Italy. METHODS A questionnaire was sent to all 107 directors of Italian level III centres between April and August 2012. RESULTS There was a 92% (n = 98) response rate. A polyethylene bag/wrap was used by 54 centres (55.1%), with the highest rate in Northern Italy (77.5%) and the lowest rate in Southern (37.7%) areas. In Northern regions, one centre (2.5%) said it used oxygen concentrations >40% to initiate positive pressure ventilation in ELBW infants. These proportions were higher in the Central (14.3%) and Southern (16.2%) areas. A T-piece device for positive pressure ventilation was more frequently available in the Northern (95%) units than in those in the Central (66.7%) and Southern (69.4%) regions. A median of 13% (IQR: 5%-30%) of ELBW infants received chest compressions at birth in Italy: 5%, 18% and 22% in Northern, Central and Southern units, respectively. CONCLUSION In Italy, delivery room management of ELBW infants showed marked geographical variations. Implementation of national training programmes could increase adherence to the guidelines and reduce such discordance.
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Affiliation(s)
- Daniele Trevisanuto
- Children and Women's Health Department; Medical School University of Padua Azienda; Padua Italy
| | - Irene Satariano
- Children and Women's Health Department; Medical School University of Padua Azienda; Padua Italy
| | - Nicoletta Doglioni
- Children and Women's Health Department; Medical School University of Padua Azienda; Padua Italy
| | - Giulio Criscoli
- Italian Army - Signals and Information Technology HQ - C4 Systems Integration Development; Treviso Italy
| | | | - Camilla Gizzi
- Neonatal Intensive Care Unit Pediatric; Neonatal Department ‘S.Giovanni Calibita’; Fatebenefratelli Hospital; Rome Italy
| | - Claudio Martano
- Neonatal Intensive Care Unit; Pediatric Department; Medical School University of Turin; Azienda Ospedaliera OIRM-S; Torino Italy
| | - Fabrizio Ciralli
- Neonatal Intensive Care Unit; Department of Mother and Infant Science Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; University of Milan; Milan Italy
| | - Flaminia Torielli
- Neonatology Unit; University of Genova; Azienda Ospedaliera San Martino IRCCS - IST National Institute on Cancer Research; Genova Italy
| | - Paolo E. Villani
- Neonatal Intensive Care Unit; Maternal and Pediatric Department; Carlo Poma Hospital; Mantova Italy
| | - Sandra Di Fabio
- Neonatal Intensive Care Unit; Department of Mother and Infant Science; ‘San Salvatore’ Hospital; L'Aquila Italy
| | | | - Luigi Giannini
- Pediatric Department; Medical School University ‘La Sapienza’ Rome Azienda Ospedaliera Policlinico Umberto; Rome Italy
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Partridge MR. Medicine: a rethink? Are entrants to the profession and the way it is organised fit for purpose? Clin Med (Lond) 2014; 14:225-8. [PMID: 24889563 PMCID: PMC4952531 DOI: 10.7861/clinmedicine.14-3-225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The health burden in most countries has changed. Although acute care is needed for trauma, acute illness and exacerbations of chronic disease, most of the burden is now long term. These patients need different approaches, with more emphasis upon supporting self-management, enhancing lifestyle changes, aiding compliance by shared decision-making and providing more convenient follow-up that appreciates the likelihood of multimorbidity. Integrated care will increasingly be offered from within the community. The current hospital- and doctor-centric focus needs to change to one where specialists work in the community as much as in hospitals and share this different type of care with others. For potential future doctors, the scientific basis of medicine will still underpin their unique role in diagnosis and prescribing, but they will need to understand these other changes and to be selected according to attributes compatible with their future role, and then be trained and assessed accordingly.
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McCall E, Alderdice F, Halliday H, Johnston L, Vohra S. Challenges of Minimizing Heat Loss at Birth: A Narrative Overview of Evidence-Based Thermal Care Interventions. ACTA ACUST UNITED AC 2014. [DOI: 10.1053/j.nainr.2014.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Ichinose M, Kamei Y, Iriyama T, Imada S, Seyama T, Toshimitsu M, Asou H, Yamamoto M, Fujii T. Hypothermia attenuates apoptosis and protects contact between myelin basic protein-expressing oligodendroglial-lineage cells and neurons against hypoxia-Ischemia. J Neurosci Res 2014; 92:1270-85. [DOI: 10.1002/jnr.23418] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Mari Ichinose
- Department of Obstetrics and Gynecology; Graduate School of Medicine, University of Tokyo; Tokyo Japan
| | - Yoshimasa Kamei
- Department of Obstetrics and Gynecology; Graduate School of Medicine, University of Tokyo; Tokyo Japan
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology; Graduate School of Medicine, University of Tokyo; Tokyo Japan
| | - Shinya Imada
- Department of Obstetrics and Gynecology; Graduate School of Medicine, University of Tokyo; Tokyo Japan
| | - Takahiro Seyama
- Department of Obstetrics and Gynecology; Graduate School of Medicine, University of Tokyo; Tokyo Japan
| | - Masatake Toshimitsu
- Department of Obstetrics and Gynecology; Graduate School of Medicine, University of Tokyo; Tokyo Japan
| | - Hiroaki Asou
- Center for Kampo Medicine, Keio University School of Medicine; Tokyo Japan
| | | | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology; Graduate School of Medicine, University of Tokyo; Tokyo Japan
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Nimbalkar SM, Patel VK, Patel DV, Nimbalkar AS, Sethi A, Phatak A. Effect of early skin-to-skin contact following normal delivery on incidence of hypothermia in neonates more than 1800 g: randomized control trial. J Perinatol 2014; 34:364-8. [PMID: 24556982 DOI: 10.1038/jp.2014.15] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 12/17/2013] [Accepted: 01/06/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate the impact of early skin-to-skin contact (SSC) provided for first 24 h on incidence of hypothermia in stable newborns weighing 1800 g or more during first 48 h of life. STUDY DESIGN Stable newborns (term and late preterm: Mean gestational age 37.7 (1.35) weeks, range 34-40 weeks) having birth weight 1800 g or more (Mean weight 2605.6 (419.8) grams) were enrolled after approval from Institutional Human Research Ethics Committee (CTRI/2013/06/003790) and randomized into early SSC (intervention group) and conventional care (control group). Initial care in the delivery room for few minutes immediately after birth in both the groups was given under radiant warmer. In the intervention group, newborns were provided SSC by their mother started between 30 min and 1 h after birth for first 24 h with minimal interruption and were provided conventional care other than SSC for next 24 h of life. In the control group, newborns were kept with their mother and received conventional care other than SSC for first 48 h. Temperature and heart rate of newborns were recorded at 30 min, 1, 2, 3, 4, 5, 6, 12, 24 and at 48 h of life in both the groups. Independent Samples t-Test and relative risk were used to analyze the data. RESULT Both groups had 50 neonates each with similar baseline characteristics. Heart rates were in normal range in both the groups. The intervention group provided an average (s.d.) of 16.98 (0.28) h of SSC over the first 24 h period. The mean temperature was significantly high in the SSC group at all time intervals starting from 1 to 48 h (P<0.05 for all). In the SSC group only two newborns (4%) had mild hypothermia (cold stress), and, of these two newborns, one had two episodes of hypothermia. All these three episodes of hypothermia occurred within first 3 h of life. In the control group 16 newborns (32%) developed hypothermia (temperature<36.5 °C) during first 48 h of life. Of them, 11 newborns had single episode, 4 newborns had two episodes and one newborn had three episodes of hypothermia. Of these 22 hypothermic episodes, 20 occurred in the first 6 h of life and 2 episodes occurred at 48 h of life. Moderate hypothermia was seen in two newborns, whereas rest had mild hypothermia. The relative risk of developing hypothermia in the control group as compared with the SSC group was 8.00 (95% CI 1.94-32.99). There was no seasonal variation in incidence of hypothermia in both the groups. CONCLUSION Newborns in the SSC group achieved rapid thermal control as compared with the control group. Early SSC for 24 h after birth decreases incidence of hypothermia for initial 48 h of life. Early SSC needs to be aggressively promoted in term and late-preterm newborns to reduce incidence of hypothermia.
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Affiliation(s)
- S M Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, India
| | - V K Patel
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, India
| | - D V Patel
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, India
| | - A S Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, India
| | - A Sethi
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, India
| | - A Phatak
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, India
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Prevention and management of neonatal hypothermia in rural Zambia. PLoS One 2014; 9:e92006. [PMID: 24714630 PMCID: PMC3979664 DOI: 10.1371/journal.pone.0092006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/18/2014] [Indexed: 01/21/2023] Open
Abstract
Background Neonatal hypothermia is increasingly recognized as a risk factor for newborn survival. The World Health Organization recommends maintaining a warm chain and skin-to-skin care for thermoprotection of newborn children. Since little is known about practices related to newborn hypothermia in rural Africa, this study's goal was to characterize relevant practices, attitudes, and beliefs in rural Zambia. Methods and Findings We conducted 14 focus group discussions with mothers and grandmothers and 31 in-depth interviews with community leaders and health officers in Lufwanyama District, a rural area in the Copperbelt Province, Zambia, enrolling a total of 171 participants. We analyzed data using domain analysis. In rural Lufwanyama, community members were aware of the danger of neonatal hypothermia. Caregivers' and health workers' knowledge of thermoprotective practices included birthplace warming, drying and wrapping of the newborn, delayed bathing, and immediate and exclusive breastfeeding. However, this warm chain was not consistently maintained in the first hours postpartum, when newborns are at greatest risk. Skin-to-skin care was not practiced in the study area. Having to assume household and agricultural labor responsibilities in the immediate postnatal period was a challenge for mothers to provide continuous thermal care to their newborns. Conclusions Understanding and addressing community-based practices on hypothermia prevention and management might help improve newborn survival in resource-limited settings. Possible interventions include the implementation of skin-to-skin care in rural areas and the use of appropriate, low-cost newborn warmers to prevent hypothermia and support families in their provision of newborn thermal protection. Training family members to support mothers in the provision of thermoprotection for their newborns could facilitate these practices.
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Neonatal adenoviral infection: a seventeen year experience and review of the literature. J Pediatr 2014; 164:529-35.e1-4. [PMID: 24359940 DOI: 10.1016/j.jpeds.2013.11.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 09/17/2013] [Accepted: 11/05/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe the clinical manifestations and short-term outcomes of adenoviral infections in neonates and review all published cases to better determine impact and treatment outcomes. STUDY DESIGN Retrospective cohort study of all neonates hospitalized at Children's Medical Center (CMC) and Parkland Memorial Hospital (PMH), Dallas, TX with laboratory-confirmed adenoviral infection from January 1,1995-December 31, 2012. Neonates were identified by review of the CMC Virology Laboratory's prospective database of all positive adenovirus tests performed in the inpatient and ambulatory settings, and at PMH, of a prospective neonatal database that included all neonatal intensive care unit admissions. Patients also were identified by discharge International Classification of Disease, 9th edition codes for adenoviral infection. The medical records were reviewed, and a review of the English literature was performed. RESULTS During 17 years, 26 neonates had adenoviral infection (25, CMC; 1, PMH). The principle reasons for hospitalization were respiratory signs (88%) and temperature instability (65%). Five (19%) had disseminated disease and 4 (80%) of these infants died. Ribavirin or cidofovir treatment, as well as immune globulin intravenous, did not improve outcomes except in 1 neonate. Literature review (n = 72) combined with our data found that disseminated infection was associated with death (68% vs 21% with localized infection, P < .001). In addition, neonates <14 days of age were more likely to have disseminated disease (44% vs 12%, P = .004) and death (48% vs 8%; P < .001). CONCLUSION Adenoviral infection in hospitalized neonates was associated with severe morbidity and mortality, especially when infection was disseminated and involved the respiratory tract. Development of new therapeutic strategies is needed.
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Khanal V, Gavidia T, Adhikari M, Mishra SR, Karkee R. Poor thermal care practices among home births in Nepal: further analysis of Nepal Demographic and Health Survey 2011. PLoS One 2014; 9:e89950. [PMID: 24587145 PMCID: PMC3938557 DOI: 10.1371/journal.pone.0089950] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/24/2014] [Indexed: 01/21/2023] Open
Abstract
Introduction Hypothermia is a major factor associated with neonatal mortality in low and middle income countries. Thermal care protection of newborn through a series of measures taken at birth and during the initial days of life is recommended to reduce the hypothermia and associated neonatal mortality. This study aimed to identify the prevalence of and the factors associated with receiving ‘optimum thermal care’ among home born newborns of Nepal. Methods Data from the Nepal Demographic and Health Surveys (NDHS) 2011 were used for this study. Women who reported a home birth for their most recent childbirth was included in the study. Factors associated with optimum thermal care were examined using Chi-square test followed by logistic regression. Results A total of 2464 newborns were included in the study. A total of 57.6 % were dried before the placenta was delivered; 60.3% were wrapped; 24.5% had not bathing during the first 24 hours, and 63.9% were breastfed within one hour of birth. Overall, only 248 (10.7%; 95% CI (8.8 %, 12.9%)) newborns received optimum thermal care. Newborns whose mothers had achieved higher education (OR 2.810; 95% CI (1.132, 6.976)), attended four or more antenatal care visits (OR 2.563; 95% CI (1.309, 5.017)), and those whose birth were attended by skilled attendants (OR 2.178; 95% CI (1.428, 3.323)) were likely to receive optimum thermal care. Conclusion The current study showed that only one in ten newborns in Nepal received optimum thermal care. Future newborn survival programs should focus on those mothers who are uneducated; who do not attend the recommended four or more attend antenatal care visits; and those who deliver without the assistance of skilled birth attendants to reduce the risk of neonatal hypothermia in Nepal.
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Affiliation(s)
- Vishnu Khanal
- School of Public Health, Curtin University, Perth, Australia
- * E-mail:
| | - Tania Gavidia
- Centre for International Health, Curtin University, Perth, Australia
| | | | | | - Rajendra Karkee
- School of Public Health, Curtin University, Perth, Australia
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
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de Almeida MFB, Guinsburg R, Sancho GA, Rosa IRM, Lamy ZC, Martinez FE, da Silva RPGVC, Ferrari LSL, de Souza Rugolo LMS, Abdallah VOS, Silveira RDC. Hypothermia and early neonatal mortality in preterm infants. J Pediatr 2014; 164:271-5.e1. [PMID: 24210925 DOI: 10.1016/j.jpeds.2013.09.049] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/22/2013] [Accepted: 09/20/2013] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate intervention practices associated with hypothermia at both 5 minutes after birth and at neonatal intensive care unit (NICU) admission and to determine whether hypothermia at NICU admission is associated with early neonatal death in preterm infants. STUDY DESIGN This prospective cohort included 1764 inborn neonates of 22-33 weeks without malformations admitted to 9 university NICUs from August 2010 through April 2012. All centers followed neonatal International Liaison Committee on Resuscitation recommendations for the stabilization and resuscitation in the delivery room (DR). Variables associated with hypothermia (axillary temperature <36.0 °C) 5 minutes after birth and at NICU admission, as well as those associated with early death, were analyzed by logistic regression. RESULTS Hypothermia 5 minutes after birth and at NICU admission was noted in 44% and 51%, respectively, with 6% of early neonatal deaths. Adjusted for confounding variables, practices associated with hypothermia at 5 minutes after birth were DR temperature <25 °C (OR 2.13, 95% CI 1.67-2.28), maternal temperature at delivery <36.0 °C (OR 1.93, 95% CI 1.49-2.51), and use of plastic bag/wrap (OR 0.53, 95% CI 0.40-0.70). The variables associated with hypothermia at NICU admission were DR temperature <25 °C (OR 1.44, 95% CI 1.10-1.88), respiratory support with cold air in the DR (OR 1.40, 95% CI 1.03-1.88) and during transport to NICU (OR 1.51, 95% CI 1.08-2.13), and cap use (OR 0.55, 95% CI 0.39-0.78). Hypothermia at NICU admission increased the chance of early neonatal death by 1.64-fold (95% CI 1.03-2.61). CONCLUSION Simple interventions, such as maintaining DR temperature >25 °C, reducing maternal hypothermia prior to delivery, providing plastic bags/wraps and caps for the newly born infants, and using warm resuscitation gases, may decrease hypothermia at NICU admission and improve early neonatal survival.
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Affiliation(s)
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil.
| | - Guilherme Assis Sancho
- Division of Neonatal Medicine, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Izilda Rodrigues Machado Rosa
- Department of Pediatrics, Universidade Estadual de Campinas/Hospital da Mulher Prof. Dr. José Aristodemo Pinotti, Campinas, SP, Brazil
| | - Zeni Carvalho Lamy
- Department of Public Health, Universidade Federal do Maranhão/Hospital Universitário, São Luís, MA, Brazil
| | - Francisco Eulógio Martinez
- Department of Pediatrics, Universidade de São Paulo/Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | | | - Lígia Silvana Lopes Ferrari
- Department of Pediatrics and Pediatric Surgery, Universidade Estadual de Londrina/Hospital Universitário, Londrina, PR, Brazil
| | | | | | - Rita de Cássia Silveira
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Chitty H, Wyllie J. Importance of maintaining the newly born temperature in the normal range from delivery to admission. Semin Fetal Neonatal Med 2013; 18:362-8. [PMID: 24055301 DOI: 10.1016/j.siny.2013.08.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Over the last 50 years an increasing amount of evidence on neonatal resuscitation and stabilisation practices has led to written recommendations on all aspects of newborn care in the first few minutes of life. Much evidence for thermoregulatory management of both term and preterm infants has existed for decades and more recently research has identified new techniques to maintain normothermia in newly born infants. The use of increased environmental temperatures, skin-to-skin care, radiant warmers, plastic coverings and hats, exothermic mattresses and heated humidified gases have or are undergoing evaluation. However, despite the apparent acceptance of these techniques, a substantial number of infants continue to become hypothermic soon after delivery, leading to an increased risk of comorbidities and of death. Gaps in our knowledge remain and further research opportunities are available. However, we must also ensure that established thermoregulatory methods for which the evidence already exists are given as much emphasis as other aspects of newborn care and are implemented meticulously in all healthcare settings.
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Affiliation(s)
- Helen Chitty
- Department of Neonatology, The James Cook University Hospital, Marton Road, Middlesbrough, Teesside TS4 3BW, UK
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Birbeck G. Medicine for global health: can "simple interventions" improve the worldwide burden of disease? BMC Med 2013; 11:72. [PMID: 23496983 PMCID: PMC3621694 DOI: 10.1186/1741-7015-11-72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/06/2013] [Indexed: 01/21/2023] Open
Abstract
Improvements to medical practice and delivery of treatment has been the focus of many international collaborations aiming to address the delivery of appropriate health care in low- and middle-income countries. However, this is compounded by various social, cultural as well as resource allocation issues. This Editorial marks the launch of an article collection on Medicine for Global Health (http://www.biomedcentral.com/bmcmed/series/medicine_for_global_health), and here, guest editor Gretchen Birbeck discusses the challenges, importance and increasing relevance of global health.
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