Impact of temperature change from admission to day one on neonatal mortality in a low-resource setting

Francesco Cavallin, Serena Calgaro, Valentina Brugnolaro, Amir Hussein Abubacar Seni, Arlindo Rosario Muhelo, Liviana Da Dalt, Giovanni Putoto, Daniele Trevisanuto, Francesco Cavallin, Serena Calgaro, Valentina Brugnolaro, Amir Hussein Abubacar Seni, Arlindo Rosario Muhelo, Liviana Da Dalt, Giovanni Putoto, Daniele Trevisanuto

Abstract

Background: Thermal control after birth is an essential part of neonatal care. However, the relationship between neonatal temperature at and after admission is unknown. This study aimed to evaluate the change between neonatal temperature at admission and at day 1, and its impact on mortality.

Methods: Retrospective observational study at the Beira Central Hospital, Mozambique. Axillary temperatures were recorded at admission and at day 1 in 1,226 neonates who were admitted to the Special Care Unit between January 1 and December 31, 2017. The relationship between mortality rate and temperature change was evaluated with a matrix plot and a forest plot (obtained from a logistic regression model as odds ratios with 95% confidence intervals).

Results: Normothermia was found in 415 neonates (33.8%) at admission and in 638 neonates (52.0%) at day 1. Mortality rate was highest in (i) neonates who remained in severe/moderate hypothermia (74%), (ii) neonates who rewarmed from hypothermia (40-55%), and (iii) neonates who chilled to severe/moderate hypothermia (38-43%). Multivariable analysis confirmed that temperature change from admission to day 1 was an independent predictor of mortality (p < 0.0001).

Conclusions: In a low-resource setting, one out of three neonates was found hypothermic at day 1 irrespectively of admission temperature. Relevant thermal deviations occurred in a high proportion of newborns with normothermia at admission. Being cold at admission and becoming cold or hyperthermic at day 1 were associated with increased likelihood of mortality. Appropriate actions to prevent both hypothermia and hyperthermia represent both a challenge and a priority during postnatal period.

Keywords: Birth; Hypothermia; Low-resource setting; Mortality; Temperature.

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Neonatal temperatures at admission and day 1: scatterplot and boxplots (a), Bland-Altman-like plot (b), and change in temperature categories (c)
Fig. 2
Fig. 2
Mortality rate according to change in neonatal temperatures from admission to day 1: matrix plot (a) and forest plot (with log odds ratios and 95% confidence intervals with respect to neonates who remained in normothermia) (b)

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