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JINJA REGIONAL REFERRAL HOSPITAL
Improving Neonatal Thermal Monitoring And Care -
The Role of the Champion Parent
Dr Jenny WoodruffDr Johanna Gaiottino
Sister Anguparu MaburukaSpecial Care Baby Unit, Jinja Regional Referral Hospital
Why?
• Neonatal mortality contributes 40% of under 5 mortality worldwide
• 14% of births worldwide are of low birth weight
Is neonatal hypothermia a big problem in Africa?
................the simple answer is yes!
Prevalence data:Zambia 44% - 69%Ethiopia 53%Nigeria 62% - 68%Zimbabwe 85%
Lunze et al. BMC Medicine 2013, 11:24. The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival
Hypothermia – why does it matter?WHO definitions of hypothermia
− Mild 36.0 – 36.5 − Mod 32.0 – 36.0 − Severe <32.0
- now thought to be outdated
We need to correct the myth that the only temperature worth worrying about is <32oC!
Hypothermia - why does it matter?
Definition(Mullany et al, 2010)
Temperature range (oC)
Risk of death (adjusted for age/ambient temp)
Normothermic 36.5 – 37.5 1
Mild hypothermia 36.0 – 36.4 1.8 times higher
Moderate hypothermia 35.0 – 35.9 3 times higher
Severe hypothermia 34.0 – 34.9 10 times higher
Very severe hypothermia ≤33.9 25 times higher
Hypothermia means the baby is more likely to die!
Hypothermia - why does it matter?
Definition(Mullany et al, 2010)
Temperature range (oC)
Risk of death (adjusted for age/ambient temp)
Normothermic 36.5 – 37.5 1
Mild hypothermia 36.0 – 36.4 1.8 times higherModerate hypothermia 35.0 – 35.9 3 times higherSevere hypothermia 34.0 – 34.9 10 times higherVery severe hypothermia ≤33.9 25 times higher
Hypothermia means the baby is more likely to die!
What about in Uganda?In 2006 in SCU in Mulago, 29% of newborn deaths were
associated with hypothermia
79% of 300 newborns in St Francis Hospital, Nsambya, were hypothermic within 90 minutes of delivery‒ Higher frequency in babies who did not have skin to
skin contact with their mothers, or who were bathed within 1 hour of birth
Ministry of Health. Situation analysis of newborn health in Uganda: current status and opportunities to improve care and survival. Kampala: Government of Uganda. Save the Children, UNICEF, WHO; 2008
Byaruhanga et al, Neonatal hypothermia in Uganda: prevalence and risk factors. J Trop Pediatr. 2005
What did the parents do?Parents asked to record temperatures 6 hourly
Solar thermometers used
Chart included simple instructions on what to do in the case of mild, moderate or severe hypothermia
Temperature monitoring champion parent oversaw the process
But did this intervention help?
MethodsRetrospective audit of notes
Inclusion criteria: Birth weight <2kg Admitted September-October 2014Admitted February-March 2015
Every temperature recorded in the notes was analysed (517 temperatures in Sept-Oct and 534 temperatures in Feb-Mar)
Results: number of temperatures recordedAverage numbers of temperatures recorded
per day of admission increased from 1.2 temperatures taken per day to 1.9 (p<0.001)
Highly significant change, despite absence of several temperature charts from the post-intervention notes
Results: average temperatureAverage temperature increased from 36.28oC (95% CI +/-0.08) to
36.43oC (95% CI +/- 0.06) (p<0.01)
0 1 236.2
36.25
36.3
36.35
36.4
36.45
Sept to Oct Feb to Mar
Results: temperatures by categorySept and Oct
3%
7%
20%
21%
50%
Sept and Oct 1% 2%
18%
25%54%
Feb and Mar
Very severe (<33.9)
Severe (34.0 - 34.9)
Moderate (35.0 - 35.9)
Mild (36.0 - 36.4)
Normal / mildly pyrexic (36.5 - 37.9)
Results:Severely hypothermic temperatures (≤34.9oC)
reduced significantly from 8.9% to 2.8% (p<0.0001).
Moderately and severely hypothermic temperatures (≤35.9oC) decreased significantly from 27.9% to 19.9% (p<0.01).
Results: Did not reach significanceThe percentage of days of admission with
severe hypothermia (≤34.9oC) reduced from 8.1% to 4.6% (p<0.07) but did not reach statistical significance.
The number of deaths, discharges and “runaways” did not change significantly.
ConclusionIncreased number of temperatures
measured per patient admission day Increase in average temperatureA decrease in moderate and severe
hypothermic temperaturesEmpowerment of mothers to monitor
their babies’ temperatures