AUTHOR=Wainaina John , Ogero Morris , Mumelo Livingstone , Wairoto Kefa , Mbevi George , Tuti Timothy , Mwaniki Paul , Irimu Grace , English Mike , Aluvaala Jalemba , The Clinical Information Network Author Group , Mochache Dolphine , Vitalis Juma , Bonface Nyumbile , Manyasi Christine , Emadau Caren , Nzioki Charles , Mwangi Wagura , Kuria Magdalene , Njiru Esther , Mwangi Penina , Inginia Rachel , Namulala Emma , Ochieng Grace , Thuranira Lydia , Makokha Felistus , Ojigo Josephine , Maina Beth , Lusweti Bernadette , Ngoda Amilia , Mochache Dolphine , Mbungu Jane , Baswetty Joan , Aritho Josephine , Njambi Beatrice , Kioni Zainab , Kinyua Lucy , Oguda Alice , Mwangi Loise N. , Mburu Nancy , Muteshi Celestine , Muyale Salome Okisa , Mueni Faith , Mututa Rosemary , Oketch Joyce , Nyakina Orina , Njeru Faith , Mwaura Margaret Wanjiku , Kulubi Seline , Wanjala Susan , Njeru Pauline , Ollongo John , Soita Samuel , Nguri Mary , Waweru Margaret , Obop Otieno George , Kuya Jeska , Muthiani Esther , Mwangi Esther , Ng’ang’a Joseph , Tanui Benjamin , Wanjau Alfred , Onsongo Judith , Muigai Peter , Namayi Arnest TITLE=Hypothermia amongst neonatal admissions in Kenya: a retrospective cohort study assessing prevalence, trends, associated factors, and its relationship with all-cause neonatal mortality JOURNAL=Frontiers in Pediatrics VOLUME=12 YEAR=2024 URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2024.1272104 DOI=10.3389/fped.2024.1272104 ISSN=2296-2360 ABSTRACT=Background

Reports on hypothermia from high-burden countries like Kenya amongst sick newborns often include few centers or relatively small sample sizes.

Objectives

This study endeavored to describe: (i) the burden of hypothermia on admission across 21 newborn units in Kenya, (ii) any trend in prevalence of hypothermia over time, (iii) factors associated with hypothermia at admission, and (iv) hypothermia's association with inpatient neonatal mortality.

Methods

A retrospective cohort study was conducted from January 2020 to March 2023, focusing on small and sick newborns admitted in 21 NBUs. The primary and secondary outcome measures were the prevalence of hypothermia at admission and mortality during the index admission, respectively. An ordinal logistic regression model was used to estimate the relationship between selected factors and the outcomes cold stress (36.0°C–36.4°C) and hypothermia (<36.0°C). Factors associated with neonatal mortality, including hypothermia defined as body temperature below 36.0°C, were also explored using logistic regression.

Results

A total of 58,804 newborns from newborn units in 21 study hospitals were included in the analysis. Out of these, 47,999 (82%) had their admission temperature recorded and 8,391 (17.5%) had hypothermia. Hypothermia prevalence decreased over the study period while admission temperature documentation increased. Significant associations were found between low birthweight and very low (0–3) APGAR scores with hypothermia at admission. Odds of hypothermia reduced as ambient temperature and month of participation in the Clinical Information Network (a collaborative learning health platform for healthcare improvement) increased. Hypothermia at admission was associated with 35% (OR 1.35, 95% CI 1.22, 1.50) increase in odds of neonatal inpatient death.

Conclusions

A substantial proportion of newborns are admitted with hypothermia, indicating a breakdown in warm chain protocols after birth and intra-hospital transport that increases odds of mortality. Urgent implementation of rigorous warm chain protocols, particularly for low-birth-weight babies, is crucial to protect these vulnerable newborns from the detrimental effects of hypothermia.