Association of neonatal hypothermia with morbidity and mortality in a tertiary hospital in Malawi

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Kamuzu University of Health Sciences
Neonatal hypothermia is a major risk factor for morbidity and mortality in the first 28 days of life. Studies conducted, in high resource setting have shown the impact of hyperthermia on morbidity and mortality in the first 28 days of life, which has lead to better implementation of prevent measures. In sub-Saharan Africa, very limited data on the effect of hyperthermia on morbidity and mortality is available. Due to lack of data, this has led to poorly implemented interventions and slow reduction in the neonatal mortality rate. This study aimed to document the level of neonatal morbidity and mortality, associated with neonatal hypothermia. It determined whether hypothermia at 5 minutes, on admission to the neonatal unit (NU), or at 24 hours, had the highest association with morbidity and mortality. This prospective observational study which was conducted at Queen Elizabeth Central Hospital, Blantyre Malawi recruited neonates with a birth weight greater than 1000 grams. Temperatures were recorded at birth, on admission and 4 hourly thereafter. Clinical course and outcome were reviewed. Data were analysed using Stata v.15 and p <0.05 was considered statistically significant. Between August 2018 to March 2019, 120 neonates were enrolled, of which 112 had complete data and were included in the data analysis. Hypothermia at 5 minutes after birth was noted in 74% (83), 77% (86) on admission to the NU and 38% (24/63) at 24 hours. Neonates who had hypothermia 5 minutes after birth were more likely to have hypothermia on admission to the NU compared to normothermic subjects (p<0.01). Hypothermia on admission to the NU was significantly associated with mortality (100% v.72%, p=0.02) but not hypothermia at 5 minutes nor at 24 hours. After adjusting for potential confounders, the odds ratio of Apgar scores <6 at 1 minute for mortality was 5.66 (95% CI 1.55-20.70) for neonates with hypothermia compared to normothermia, and of hypothermia at 5 minutes for hypothermia on admission to NU was 13.31 (95% CI 4.17-42.54. This study highlights the large proportion of hospitalized neonates who are hypothermic on admission and the association between neonatal hypothermia and poor outcome in terms of morbidity and mortality. Our findings suggest that a strong predictor of mortality is neonatal hypothermia on admission to the NU, and that early intervention in the immediate period after delivery could decrease the incidence of hypothermia and reduce associated morbidity and mortality.