Neonatal Hypothermia: a Retrospective Study on Association Between Admission Temperature and Mortality and Major Morbidity in Very Low Birth Weight (Vlbw) Neonates at Day Seven of Life in Kenyatta National Hospital New Born Unit.

Abstract

Study Background Neonatal hypothermia prevalence is high as shown by studies both locally and internationally. Studies showing the incidence and associated factors of neonatal hypothermia have been conducted, however, there has been no study in our setting to describe the associations between neonatal hypothermia and short-term outcomes in Kenya. This study aims to compare the outcomes of VLBW neonates admitted with hypothermia with those admitted with normal body temperatures at seven days of admission. The study outcomes will include: Late onset neonatal sepsis, intraventricular hemorrhage, respiratory distress syndrome, necrotizing enterocolitis hypoglycemia, and mortality within seven days of admission. Broad objective. To evaluate the correlation of admission hypothermia with mortality and major morbidity at day seven of life among VLBW neonates admitted at KNH NBU Study design and site The study was a retrospective cohort study on VLBW neonates admitted to KNH NBU from January 2019 to December 2019. This retrospective study was conducted in Kenyatta National Hospital (KNH) health records department. Study materials and methods This study was a retrospective cohort study. A data abstraction tool was developed that was used to extract data of interest from records of VLBW neonates admitted to KNH NBU in the year 2019. The VLBW neonates with admission hypothermia were the exposed cohort while those with normal temperatures at admission were the unexposed cohort. At seven days post-admission, the outcomes of interest were assessed in both cohorts and odds ratios were calculated. The results are presented in tables and box plots. Data management Once the data abstraction tools were completed, the information was filled in an excel spreadsheet. The data was manually cleaned and then exported to SPSS version 25 software for further analysis. We ran a bivariate analysis using odds ratios to assess the association between temperature and the development of comorbidities during the first 7 days of admission in the neonatal unit Descriptive statistics were used to calculate the results in mean, mode and median, and frequencies. Logistic regression in SPSS will be run on outcomes whose statistical p-value will be <0.05 to determine their odds ratio of association with admission hypothermia. The results were presented in odds ratios and p values. The significance of the statistical tests was considered if they lie within the 5 % significance level. Results Admission hypothermia was associated with an increased risk of developing late-onset neonatal sepsis (LONNS) by 11 times OR-11.35 (95% CI, 6.14, 20.96 p<0.01) among the very low birth weight neonates within the first 7 days of admission. Moderate hypothermia increased the risk of LONNS by 19 times OR -19.3 (95% CI, 10, 36.8) while mild hypothermia at admission increased the risk fourfold. Neonates with very low birth weight admitted with hypothermia were 13 times more likely to develop at least one episode of hypoglycemia within the first 7 days of admission (OR-13 p<0.01). Admission hypothermia was not found to be associated with the development of IVH and NEC within the first seven days of admission. Very low birth weight neonates admitted with hypothermia were 7 times more likely to have RDS persist to seven days post-admission as compared to those who have normal temperatures at admission (p< 0.01). Moderate hypothermia increased the risk of death twofold among the study population (AOR- 2.01, p-0.05) Conclusion There is an association between hypothermia at admission with comorbidities: late-onset neonatal sepsis, hypoglycaemia, and persistent RDS within the first 7 days after admission. There is no association between the admission hypothermia with NEC and IVH within the first 7 days after admission. Moderate hypothermia is associated with an increased risk of death among very low birth neonates within the first 7 days after admission.