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Ruan J, Zhong X, Qin L, Mai J, Chen J, Ding H. Incidence and risk factors of neonatal hypothermia: A systematic review and meta-analysis. Acta Paediatr 2024; 113:1496-1505. [PMID: 38647361 DOI: 10.1111/apa.17249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
AIM Hypothermia poses a threat to the health and lives of newborns. Therefore, it is essential to identify the factors that influence neonatal hypothermia and provide targeted intervention suggestions for clinical practice to reduce its occurrence. METHODS We conducted a literature search to identify factors influencing neonatal hypothermia and performed a meta-analysis to determine the prevalence of neonatal hypothermia and its associated factors. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of cohort and case-control studies, while the Agency for Healthcare Research and Quality (AHRQ) was used to evaluate the quality of cross-sectional studies. RESULTS Eighteen studies involving 44 532 newborns from 13 countries were included. The incidence of neonatal hypothermia was 52.5% (95% CI: 0.37, 0.68). Factors such as no skin-to-skin contact, prematurity, low birth weight, delayed breastfeeding, asphyxiation and resuscitation after birth, low APGAR score, not wearing a cap, and caesarean section were found to affect neonatal hypothermia. CONCLUSION Multiple factors influence neonatal hypothermia, and clinicians can utilise these factors to develop targeted intervention measures to prevent and reduce the incidence of neonatal hypothermia.
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Affiliation(s)
- Jing Ruan
- Department of Nursing, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Xuemei Zhong
- Department of Nursing, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Lijiao Qin
- Department of Nursing, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Jiaxuan Mai
- Neonatal Surgery Department, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Jiaying Chen
- Neonatal Surgery Department, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Huiyang Ding
- Neonatal Surgery Department, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
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Dimitrova A, Dimitrova A, Mengel M, Gasparrini A, Lotze-Campen H, Gabrysch S. Temperature-related neonatal deaths attributable to climate change in 29 low- and middle-income countries. Nat Commun 2024; 15:5504. [PMID: 38951496 PMCID: PMC11217431 DOI: 10.1038/s41467-024-49890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 06/19/2024] [Indexed: 07/03/2024] Open
Abstract
Exposure to high and low ambient temperatures increases the risk of neonatal mortality, but the contribution of climate change to temperature-related neonatal deaths is unknown. We use Demographic and Health Survey (DHS) data (n = 40,073) from 29 low- and middle-income countries to estimate the temperature-related burden of neonatal deaths between 2001 and 2019 that is attributable to climate change. We find that across all countries, 4.3% of neonatal deaths were associated with non-optimal temperatures. Climate change was responsible for 32% (range: 19-79%) of heat-related neonatal deaths, while reducing the respective cold-related burden by 30% (range: 10-63%). Climate change has impacted temperature-related neonatal deaths in all study countries, with most pronounced climate-induced losses from increased heat and gains from decreased cold observed in countries in sub-Saharan Africa. Future increases in global mean temperatures are expected to exacerbate the heat-related burden, which calls for ambitious mitigation and adaptation measures to safeguard the health of newborns.
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Affiliation(s)
- Asya Dimitrova
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany.
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Anna Dimitrova
- Scripps Institution of Oceanography, University of California, San Diego, CA, 92037, USA
| | - Matthias Mengel
- Research Department 3, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Antonio Gasparrini
- Environment & Health Modelling (EHM) Lab, Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Hermann Lotze-Campen
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- Department of Agricultural Economics, Faculty of Life Sciences, Humboldt University of Berlin, Berlin, Germany
| | - Sabine Gabrysch
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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Urakura AK, Gajula R, Kankanala GR, Kotha R, Mendu SB, Harsha N. Effect of Neonatal Intensive Care Unit (NICU) Humidity on Neonates: A Systematic Review. Cureus 2024; 16:e58524. [PMID: 38765381 PMCID: PMC11101598 DOI: 10.7759/cureus.58524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
This study explores the role of room humidity levels in the neonate intensive care unit (NICU) and how they impact their growth and development in this fragile stage. The study considers seven relevant studies that have explored this factor in different settings. Humidity's role in developing neonatal conditions, such as respiratory distress and fungal infections, is also elaborated on. For the literature review, the study utilized PubMed, Embase, and Scopus databases to guarantee comprehensive findings on the role of NICU room humidity on neonates. By examining these studies' evidence, the research highlights the paramount need to ensure that the room has adequate moisture, as exposure to less desirable humidity levels increases mortality and the severity of morbidity rates among neonates. The fact that the majority of NICUs lack humidity control, which is required, stimulated us to conduct this review.
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Affiliation(s)
| | - Ravi Gajula
- Pediatrics, Government Medical College Siddipet, Siddipet, IND
| | | | - Rakesh Kotha
- Neonatology, Osmania Medical College, Hyderabad, IND
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Mvula MG, Frade Garcia A, Namwali L, Matanje BL, Mphande I, Munyaneza F, Kapira S, Hansen A. Introduction of a novel neonatal warming device in Malawi: an implementation science study. Int Health 2024:ihad114. [PMID: 38214598 DOI: 10.1093/inthealth/ihad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/09/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Neonatal hypothermia significantly contributes to infant morbidity and mortality in low-resource settings like Malawi. Kangaroo mother care (KMC) is essential but faces challenges in providing continuous thermal support. The Dream Warmer is a neonatal warming device that was developed to complement KMC. We studied its implementation outside a research environment. METHODS Using an implementation science approach, we conducted a prospective interventional cohort study in two hospitals and four health centres in Malawi. Through audits and surveys, we assessed the effect of the Dream Warmer on neonatal hypothermia as well as healthcare provider (HCP) and parent attitudes regarding thermoregulation and related issues. RESULTS The Dream Warmer raised no safety concerns and effectively treated hypothermia in 90% of uses. It was positively received by HCPs and parents, who reported it had a favourable effect on the care of small and sick newborns. Challenges identified included a scarcity of water and electricity, lack of availability of the device and HCPs forgetting to prepare it in advance of need or to use it when indicated. Feedback for future training was obtained. The Dream Warmer's strong safety and effectiveness performance is consistent with results from strict research studies. Training materials can be adapted to optimize integration into daily practice and provide educational content for parents. CONCLUSIONS The Dream Warmer is a safe and effective device to treat neonatal hypothermia, particularly when KMC is insufficient. We gained an understanding of how to optimize implementation through robust HCP and family education to help combat hypothermia.
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Affiliation(s)
| | - Alejandro Frade Garcia
- Boston Children's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | | | | | | | | | | | - Anne Hansen
- Boston Children's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
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Bucher SL, Young A, Dolan M, Padmanaban GP, Chandnani K, Purkayastha S. The NeoRoo mobile app: Initial design and prototyping of an Android-based digital health tool to support Kangaroo Mother Care in low/middle-income countries (LMICs). PLOS DIGITAL HEALTH 2023; 2:e0000216. [PMID: 37878575 PMCID: PMC10599536 DOI: 10.1371/journal.pdig.0000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/12/2023] [Indexed: 10/27/2023]
Abstract
Premature birth and neonatal mortality are significant global health challenges, with 15 million premature births annually and an estimated 2.5 million neonatal deaths. Approximately 90% of preterm births occur in low/middle income countries, particularly within the global regions of sub-Saharan Africa and South Asia. Neonatal hypothermia is a common and significant cause of morbidity and mortality among premature and low birth weight infants, particularly in low/middle-income countries where rates of premature delivery are high, and access to health workers, medical commodities, and other resources is limited. Kangaroo Mother Care/Skin-to-Skin care has been shown to significantly reduce the incidence of neonatal hypothermia and improve survival rates among premature infants, but there are significant barriers to its implementation, especially in low/middle-income countries (LMICs). The paper proposes the use of a multidisciplinary approach to develop an integrated mHealth solution to overcome the barriers and challenges to the implementation of Kangaroo Mother Care/Skin-to-skin care (KMC/STS) in LMICs. The innovation is an integrated mHealth platform that features a wearable biomedical device (NeoWarm) and an Android-based mobile application (NeoRoo) with customized user interfaces that are targeted specifically to parents/family stakeholders and healthcare providers, respectively. This publication describes the iterative, human-centered design and participatory development of a high-fidelity prototype of the NeoRoo mobile application. The aim of this study was to design and develop an initial ("A") version of the Android-based NeoRoo mobile app specifically to support the use case of KMC/STS in health facilities in Kenya. Key functions and features are highlighted. The proposed solution leverages the promise of digital health to overcome identified barriers and challenges to the implementation of KMC/STS in LMICs and aims to equip parents and healthcare providers of prematurely born infants with the tools and resources needed to improve the care provided to premature and low birthweight babies. It is hoped that, when implemented and scaled as part of a thoughtful, strategic, cross-disciplinary approach to reduction of global rates of neonatal mortality, NeoRoo will prove to be a useful tool within the toolkit of parents, health workers, and program implementors.
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Affiliation(s)
- Sherri Lynn Bucher
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Community and Global Health, Richard M. Fairbanks School of Public Health, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Allison Young
- Scholarly Concentration in Public Health Certificate Program, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Madison Dolan
- Scholarly Concentration in Public Health Certificate Program, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Geetha Priya Padmanaban
- Department of Human Centered Computing, Human-Computer Interaction, Luddy School of Informatics, Computing, and Engineering, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Khushboo Chandnani
- Department of Human Centered Computing, Human-Computer Interaction, Luddy School of Informatics, Computing, and Engineering, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Saptarshi Purkayastha
- Department of BioHealth Informatics, Data Science and Health Informatics, Luddy School of Informatics, Computing, and Engineering, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
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Kyokan M, Rosa-Mangeret F, Gani M, Pfister RE. Neonatal warming devices: What can be recommended for low-resource settings when skin-to-skin care is not feasible? Front Pediatr 2023; 11:1171258. [PMID: 37181431 PMCID: PMC10167045 DOI: 10.3389/fped.2023.1171258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Hypothermia occurs frequently among clinically unstable neonates who are not suitable to place in skin-to-skin care. This study aims to explore the existing evidence on the effectiveness, usability, and affordability of neonatal warming devices when skin-to-skin care is not feasible in low-resource settings. To explore existing data, we searched for (1) systematic reviews as well as randomised and quasi-randomised controlled trials comparing the effectiveness of radiant warmers, conductive warmers, or incubators among neonates, (2) neonatal thermal care guidelines for the use of warming devices in low-resource settings and (3) technical specification and resource requirement of warming devices which are available in the market and certified medical device by the US Food and Drug Administration or with a CE marking. Seven studies met the inclusion criteria, two were systematic reviews comparing radiant warmers vs. incubators and heated water-filled mattresses vs. incubators, and five were randomised controlled trials comparing conductive thermal mattresses with phase-change materials vs. radiant warmers and low-cost cardboard incubator vs. standard incubator. There was no significant difference in effectiveness between devices except radiant warmers caused a statistically significant increase in insensible water loss. Seven guidelines covering the use of neonatal warming devices show no consensus about the choice of warming methods for clinically unstable neonates. The main warming devices currently available and intended for low-resource settings are radiant warmers, incubators, and conductive warmers with advantages and limitations in terms of characteristics and resource requirements. Some devices require consumables which need to be considered when making a purchase decision. As effectiveness is comparable between devices, specific requirements according to patients' characteristics, technical specification, and context suitability must play a primary role in the selection and purchasing decision of warming devices. In the delivery room, a radiant warmer allows fast access during a short period and will benefit numerous neonates. In the neonatal unit, warming mattresses are low-cost, effective, and low-electricity consumption devices. Finally, incubators are required for very premature infants to control insensible water losses, mainly during the first one to two weeks of life, mostly in referral centres.
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Affiliation(s)
- Michiko Kyokan
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Flavia Rosa-Mangeret
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Department of Neonatology, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Matthieu Gani
- Essential Medical Devices Foundation, Lausanne, Switzerland
| | - Riccardo E. Pfister
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Department of Neonatology, Geneva University Hospitals and Geneva University, Geneva, Switzerland
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Pellegrino J, Kanyangarara M, Agbinko-Djobalar B, Owusu PG, Sakyi KS, Baffoe P, Sackey A, Sagoe-Moses I, Dail RB. Occurrence of neonatal hypothermia and associated risk factors among low birth weight (LBW) infants in Accra, Ghana. JOURNAL OF GLOBAL HEALTH REPORTS 2023. [DOI: 10.29392/001c.55766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Neonatal hypothermia is a prominent issue in low-resource settings. Preterm and low birth weight (LBW) infants are at increased risk for developing hypothermia. If left untreated, hypothermia can lead to hypoxia, sepsis, hypoglycemia, apnea, and poor weight gain in neonates, contributing to neonatal morbidity and mortality. Identifying risk factors for neonatal hypothermia is important, especially in low-resource settings, where the burden of neonatal mortality is highest. The study sought to describe the distribution of neonatal hypothermia and examine risk factors associated with neonatal hypothermia among LBW infants admitted to Korle-Bu Teaching Hospital in Accra, Ghana. Methods Infants in the neonatal intensive care unit (NICU) at Korle-Bu Teaching Hospital, who were less than 28 days old, weighing less than <2,500 grams, and clinically stable, were enrolled. Infants of mothers under 18 years old and those expected to be discharged within 24 hours were excluded from the study. A standardized questionnaire was administered to collect information on the mother, infant, pregnancy, and birth characteristics. Axillary temperature readings were taken every 4 hours over a 24-hour monitoring period and during hypothermic events detected by the continuous temperature monitoring bracelet. Univariate and multivariate linear regression analyses with generalized estimating equations were used to examine risk factors associated with temperature. Results Of the 254 infants included in the analysis, 42.1% were male, 49.6% were very LBW (<1,500 grams), and 94.1% were preterm (<37 weeks). Of the 1,948 temperature readings, 44.5% were hypothermic (<36.5oC). Hypothermia occurred in 85.8% of infants during the 24-hour monitoring period. Multivariate linear regression demonstrated that being very LBW, having no skin-to-skin contact immediately after birth, not being wrapped or treated in an incubator at the time of temperature, and mixed feeding (compared to exclusive breastfeeding) were associated with lower neonatal temperatures. Conclusions Neonatal hypothermia was common among infants admitted to the NICU. The findings highlight the importance of thermal practices such as wrapping, exclusive breastfeeding and skin-to-skin contact. Increased education to promote thermal care is needed.
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Affiliation(s)
| | | | | | - Prince Gyebi Owusu
- Center for Learning and Childhood Development-Ghana
- Michigan State University
| | - Kwame Sarfo Sakyi
- Center for Learning and Childhood Development-Ghana
- Oakland University
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Steenhoff AP, Coffin SE, KC A, Nakstad B. Editorial: Neonatal health in low- and middle-income countries. Now is the time. Front Pediatr 2023; 11:1168915. [PMID: 37124177 PMCID: PMC10133691 DOI: 10.3389/fped.2023.1168915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
- Andrew P. Steenhoff
- Global Health Center & Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, United States
- The Botswana-UPenn Partnership, Gaborone, Botswana
- Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Susan E. Coffin
- Global Health Center & Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, United States
- The Botswana-UPenn Partnership, Gaborone, Botswana
| | - Ashish KC
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Britt Nakstad
- Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Correspondence: Britt Nakstad ;
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Swanson SJ, Martinez KK, Shaikh HA, Philipo GM, Martinez J, Mushi EJ. Every breath counts: Lessons learned in developing a training NICU in Northern Tanzania. Front Pediatr 2022; 10:958628. [PMID: 36090561 PMCID: PMC9452716 DOI: 10.3389/fped.2022.958628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Neonatal mortality rates in resource-limited hospitals of Sub-Saharan Africa (SSA) remain disproportionately high and are likely underestimated due to misclassification of extremely preterm births as "stillbirths" or "abortions", incomplete death registries, fear of repercussions from hospital and governmental authorities, unrecorded village deaths, and cultural beliefs surrounding the viability of premature newborns. While neonatology partnerships exist between high income countries and hospitals in SSA, efforts have largely been directed toward improving newborn survival through neonatal resuscitation training and provision of equipment to nascent neonatal intensive care units (NICUs). These measures are incomplete and fail to address the challenges which NICUs routinely face in low-resource settings. We draw on lessons learned in the development of a low-technology referral NICU in Tanzania that achieved an overall 92% survival rate among infants. LESSONS LEARNED Achieving high survival rates among critically ill and preterm neonates in SSA is possible without use of expensive, advanced-skill technologies like mechanical ventilators. Evidence-based protocols adapted to low-resource hospitals, mentorship of nurses and physicians, changes in hierarchal culture, improved nurse-infant staffing ratios, involvement of mothers, improved procurement of consumables and medications, and bedside diagnostics are necessary steps to achieving high survival rates. Our NICU experience indicates that low-technology solutions of thermoregulation, respiratory support via continuous positive airway pressure, feeding protocols and infection control measures can ensure that infants not only survive, but thrive. CONCLUSIONS Neonatal mortality and survival of preterm newborns can be improved through a long-term commitment to training NICU staff, strengthening basic neonatal care practices, contextually appropriate protocols, and limited technology.
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Affiliation(s)
- Stephen J Swanson
- Department of Paediatrics, Arusha Lutheran Medical Centre, Arusha, Tanzania.,Global Pediatrics Program, University of Minnesota, Minneapolis, MN, United States
| | - Kendra K Martinez
- Department of Paediatrics, Arusha Lutheran Medical Centre, Arusha, Tanzania.,Global Pediatrics Program, University of Minnesota, Minneapolis, MN, United States
| | - Henna A Shaikh
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Godbless M Philipo
- Department of Paediatrics, Arusha Lutheran Medical Centre, Arusha, Tanzania
| | - Jarian Martinez
- Department of Paediatrics, Arusha Lutheran Medical Centre, Arusha, Tanzania
| | - Evelyine J Mushi
- Department of Paediatrics, Arusha Lutheran Medical Centre, Arusha, Tanzania.,Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
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