Distribution and outcomes of neonatal admission hypothermia in a tertiary hospital in Jos Nigeria

Abstract

Background: Admission hypothermia (AH) is common and associated with adverse neonatal outcomes. The association of severity of AH with mortality is emerging however, the widely used WHO classification of neonatal hypothermia has limitations. We therefore sought to determine the severity distribution of AH, agreement between the two methods ofclassification and estimate risk of mortality in hospitalised neonates.

Methods: It was a retrospective crossectional study of 540 neonatal admissions. Anonymized data extracted from the unit electronic records. The WHO method was compared with a new method of classification of hypothermia.

Results: The prevalence of AH was 41.9% with 104 (48.0%), 88(38.9%), 23(10.2%) and 11(4.9%) neonate with Grade I(mild), Grade II, Grade III, and Grade IV (severe) AH respectively. There was moderate agreement between both methods of classifications (? = 0.740, p <0.001). Mortality was 3.4 folds in neonates with AH (16.8%) compared to those with normothermia (5.6%) (crude odds ratio [cOR] =3.381, 95% CI= 1.677-6.816). The proportion of mortality increased with severity of hypothermia with mortality rates of 14.4%, 15.9%, 21.7% and 36.4% in neonates with Grade I, Grade II, Grade III 2and Grade IV hypothermia respectively (÷ for trends= 16.407, p=<0.001). After correcting for the effect of admission age, gestational age and birth weight, there was a 6 fold increase in the risk of mortality in neonates with Grade IV(severe) AH (adjusted OR = 6.393, 95%CI= 1.552- 26.331).

Conclusion: The new method had an advantage of identifying a subpopulation of neonates with severe AH with increased risk of mortality therefore recommended.