OBJECTIVE: To quantify the neonatal mortality/hypothermia relationship and develop evidence-based cutoffs for global definitions of neonatal hypothermia. DESIGN: Cohort study. Field workers recorded neonatal axillary temperature at home and recorded vital status at 28 days. SETTING: Rural Nepal. PARTICIPANTS: Twenty-three thousand two hundred forty infants in Sarlahi, Nepal. MAIN EXPOSURE: Hypothermia. OUTCOME MEASURES: Mortality risk was estimated using binomial regression models. Infants were classified using (1) World Health Organization (WHO) cutoffs for mild, moderate, and severe hypothermia; (2) quarter-degree intervals from 32.0 degrees C to 36.5 degrees C; and (3) continuous temperatures. Estimates were adjusted for age, ambient temperature, and other potential confounders. RESULTS: Mortality increased among mild (relative risk [RR], 1.70; 95% confidence interval [CI], 1.23-2.35]), moderate (RR, 4.66; 95% CI, 3.47-6.24]), and severe (RR, 23.36; 95% CI, 4.31-126.70]) hypothermia cases. Within the WHO's moderate classification, risk relative to normothermic infants ranged from 2 to 30 times. Adjusted mortality risk increased 80% (95% CI, 63%-100%) for each degree decrease, was strongly associated with temperatures below 35.0 degrees C (RR, 6.11; 95% CI, 3.98-9.38), and was substantially higher among preterm infants (RR, 12.02; 95% CI, 6.23-23.18]) compared with full-term infants (RR, 3.12; 95% CI, 1.75-5.57). Relative risk was highest in the first 7 days, but remained elevated through 28 days. CONCLUSIONS: A new hypothermia classification system should be considered by the WHO for global guidelines. We recommend that grade 1 be equivalent to the current mild category (36.0 degrees C), restricting and splitting the moderate category into grades 2 (35.0 degrees C-36.0 degrees C) and 3 (34.0 degrees C-35.0 degrees C), and expanding severe hypothermia to less than 34.0 degrees C (grade 4). Reducing hypothermia may dramatically decrease the global neonatal mortality burden.
OBJECTIVE: To quantify the neonatal mortality/hypothermia relationship and develop evidence-based cutoffs for global definitions of neonatal hypothermia. DESIGN: Cohort study. Field workers recorded neonatal axillary temperature at home and recorded vital status at 28 days. SETTING: Rural Nepal. PARTICIPANTS: Twenty-three thousand two hundred forty infants in Sarlahi, Nepal. MAIN EXPOSURE: Hypothermia. OUTCOME MEASURES: Mortality risk was estimated using binomial regression models. Infants were classified using (1) World Health Organization (WHO) cutoffs for mild, moderate, and severe hypothermia; (2) quarter-degree intervals from 32.0 degrees C to 36.5 degrees C; and (3) continuous temperatures. Estimates were adjusted for age, ambient temperature, and other potential confounders. RESULTS: Mortality increased among mild (relative risk [RR], 1.70; 95% confidence interval [CI], 1.23-2.35]), moderate (RR, 4.66; 95% CI, 3.47-6.24]), and severe (RR, 23.36; 95% CI, 4.31-126.70]) hypothermia cases. Within the WHO's moderate classification, risk relative to normothermic infants ranged from 2 to 30 times. Adjusted mortality risk increased 80% (95% CI, 63%-100%) for each degree decrease, was strongly associated with temperatures below 35.0 degrees C (RR, 6.11; 95% CI, 3.98-9.38), and was substantially higher among preterm infants (RR, 12.02; 95% CI, 6.23-23.18]) compared with full-term infants (RR, 3.12; 95% CI, 1.75-5.57). Relative risk was highest in the first 7 days, but remained elevated through 28 days. CONCLUSIONS: A new hypothermia classification system should be considered by the WHO for global guidelines. We recommend that grade 1 be equivalent to the current mild category (36.0 degrees C), restricting and splitting the moderate category into grades 2 (35.0 degrees C-36.0 degrees C) and 3 (34.0 degrees C-35.0 degrees C), and expanding severe hypothermia to less than 34.0 degrees C (grade 4). Reducing hypothermia may dramatically decrease the global neonatal mortality burden.
Authors: Theodore C Belsches; Alyssa E Tilly; Tonya R Miller; Rohan H Kambeyanda; Alicia Leadford; Albert Manasyan; Elwyn Chomba; Manimaran Ramani; Namasivayam Ambalavanan; Waldemar A Carlo Journal: Pediatrics Date: 2013-08-26 Impact factor: 7.124
Authors: Dominique J Karas; Luke C Mullany; Joanne Katz; Subarna K Khatry; Steven C LeClerq; Gary L Darmstadt; James M Tielsch Journal: J Trop Pediatr Date: 2011-06-24 Impact factor: 1.165
Authors: Luke C Mullany; Joanne Katz; Subarna K Khatry; Steven C LeClerq; Gary L Darmstadt; James M Tielsch Journal: BMC Med Date: 2010-07-08 Impact factor: 8.775
Authors: Alicia E Leadford; Jamie B Warren; Albert Manasyan; Elwyn Chomba; Ariel A Salas; Robert Schelonka; Waldemar A Carlo Journal: Pediatrics Date: 2013-06-03 Impact factor: 7.124
Authors: Josee Uwamariya; Christian Mazimpaka; Leana May; Alphonse Nshimyiryo; Henry A Feldman; Felix Sayinzoga; Sharon Umutesi; Ashok Gadgil; Vi H Rapp; Evrard Nahimana; Anne Hansen Journal: EClinicalMedicine Date: 2021-04-16