Prevalence, risk factors and outcomes of neonatal hypothermia at admission at a tertiary neonatal unit, Kigali, Rwanda – a cross-sectional study

Abstract

Introduction

Thermoregulation remains a key physiological challenge faced by a neonate after delivery. We assessed the prevalence, risk factors and outcomes of hypothermia in admitted neonates at a tertiary teaching hospital of Kigali city in Rwanda.

Materials and methods

A cross-sectional study was conducted, from July 2013 to September 2017, of neonates who were admitted in the neonatology unit of the University Teaching Hospital of Kigali (CHUK) and whose admission temperature were recorded. Data were extracted from the neonatal database (registry).

Results

The neonatal database contained 1021 eligible neonates of which 15% were outborn. Hypothermia was found at admission in 280 of the 1021 eligible neonates (27%). The extremely preterm (<28 weeks) were significantly more likely to become hypothermic compared to term neonates (AOR = 6.81, CI: 3.39–13.71, p < .001). Mortality rate was higher in hypothermic infants (AOR = 1.89, CI: 1.16–3.1, p = .011). Length of hospital stay (22 versus 13 days, p < .001), in all surviving infants was higher in neonates admitted hypothermic, though not in the subgroups of infants < 32-week gestation.

Discussion

Thermal protection of the neonate immediately after birth is essential. In our tertiary neonatal unit, we identify nearly one-third of neonates are hypothermic at admission and this is associated with higher mortality and increased length of hospital stay. The ten-steps of the WHO “warm chain” may present an analytic roster for maternity and neonatal teams to pinpoint targets for interventional research and quality improvement work in order to achieve better outcomes.

Keywords:

• Developing countries
• hypothermia
• infant
• length of stay
• mortality
• newborn
• prevalence
• Rwanda

Acknowledgments

The laptop was a donation from Middlesex Hospital, Middletown, Connecticut, USA.

Confidentiality

All data were kept in a secured area and on a password-protected database. Names or other patients’ identification information was not disclosed publicly.

Informed consent

All admitted neonates are included in the RNDB at CHUK. Informed consent is not taken for entry into the RNDB as no direct contact is made with participants or parents.

Incentives for subjects

Subjects did not receive any incentive for this study.

Risk to subjects

No significant physical, legal, financial, emotional and/or social risks to the subjects during this study were identified.

Institutional review board (IRB)

Study approved by the CHUK Research Ethics Committee (REC); Ref: EC/CHUK/322/2017.

Data availability

Nonanalyzed datasets are not available publicly; they are available on reasonable request and approval from the local ethics committee at CHUK.

Disclosure statement

No potential conflict of interest was reported by the authors.