G265 Neonatal hypothermia – still a serious problem in a low-income country. (May 2019)

• Record Type: Journal Article
• Authors: Dastur Mackenzie, FM; Shepherd, K; Rukabyarwema, JP; Lissauer, T
• Is Part Of: Archives of disease in childhood. Volume 104:(2019)Supplement 2
• Page Start: A107
• Page End: A108
• Publication Date: 2019-05
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-rcpch.257
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: To reduce the incidence of hypothermia in babies in a neonatal unit in a large Rwandan district general hospital. Background: Neonatal hypothermia contributes significantly to neonatal mortality and morbidity globally. We identified that a high proportion of infants were hypothermic at admission and subsequently whilst receiving care both in incubators and Kangaroo Mother Care. Particular issues were that admission to the neonatal unit involved an outside journey and staff did not focus on keeping babies normothermic. Methods: A major initiative involving staff in the maternity and neonatal departments and hospital administration was undertaken. In the maternity department we taught and ran simulation sessions on effective preparation for birth, newborn resuscitation and post delivery care, including avoiding hypothermia. We obtained and introduced a thermal baby transfer warmer comprising a heated pack incorporated into a thermal blanket and with the local team built an improvised transport incubator. On the neonatal unit we trained staff on the importance of normothermia, of increasing measurements from once a day, how to intervene if abnormal and monitoring post intervention. We worked with hospital technicians to repair incubators and provided teaching for nurses and parents on kangaroo mother care. We collected data on admission temperatures and random temperatures of infants on the neonatal unit. We also recorded if the infant was in a cot, radiant warmer, incubator or in kangaroo mother care. Results: Over 6 months, admission hypothermia was reduced from 60% (n=90) to 32% (n=78). For birthweight <2.5 kg, it reduced from 76% (n=30) to 50%(n=22). For random checks of infants on the neonatal unit, hypothermia dropped from 54% (n=28) to 23% (n=30), although in kangaroo mother care it increased from 33% (n=6) to 50% (n=4). Frequency of temperature measurements increased from an average of once to 4 times per day. Conclusion: We reduced the overall incidence of neonatal hypothermia through a series of innovative interventions. However, hypothermia remains problematic. Its occurrence in infants receiving Kangaroo Mother Care was unexpected, but numbers were small and further investigation is indicated.