[8315.8] Admission Hypothermia Predicts Neonatal Mortality in a Low Resource Setting
Yvonne E. Vaucher, Margaret Nakakeeto. Div. of Neonatal-Perinatal Medicine, Univ. of California, San Diego, CA; Dept. of Paediatrics and Child Health, Makerere University, Kampala, Uganda.
BACKGROUND: Hypothermia, a common neonatal problem in low resource countries, is associated with increased morbidity and mortality in sick newborns. Hypothermia at the time of NICU admission reflects resources available to maintain body warmth during resuscitation, stabilization and transfer of acutely ill newborns.
OBJECTIVE: To determine whether hypothermia at the time of NICU admission independently predicts neonatal mortality in a low resource setting.
DESIGN/METHODS: Over 30,000 newborns are delivered per year at Mulago Hospital, the largest national referral center in Uganda, of whom approximately 8% require acute neonatal care. A computerized database for all 1720 sick newborns admitted over an eight month period (03/01/06-10/31/06) to the Special Care Baby Unit (SCBU) at Mulago Hospital, Makerere University, Kampala, Uganda included birthweight, gestational age, place and mode of delivery, Apgar score, fetal growth (SGA/AGA/LGA), gender, admission temperature, reason for admission, and survival status. Of all admissions, 82% were inborn; 49% were preterm. Almost all were admitted directly from the delivery suite. Hypothermia was classified as mild (36-36.4oC), moderate (32-35.9oC) or severe (<32oC) per WHO recommendations.
RESULTS: Over three quarters (77%) of all acutely ill newborns admitted to the SCBU were hypothermic with an overall mean admission temperature of 35.4 1.6.oC. Of all admissions, 57% were moderately hypothermic with a mortality rate of 40% and 5% were severely hypothermic with a mortality rate of 67% compared to a mortality rate of 15% for those who were either mildly hypothermic or normothermic (p<.0001). By univariate analysis, mortality was also associated (p<.0001) with decreasing gestational age (wk) and birthweight (kg), being SGA, vaginal delivery, 5 minute Apgar score < 6, and being outborn. By logistic regression, admission temperature (OR 0.59, CI 0.48-0.72, p<.0001) was a more powerful independent predictor of mortality than birthweight (0.56, CI 0.35-0.89, p=.014) or low Apgar score (OR 1.76, CI 1.1-2.79, p=.017).
CONCLUSIONS: Admission hypothermia is an important independent predictor of neonatal mortality in sick newborns. Sufficient resources to maintain normothermia during resuscitation, transfer and care of these infants are essential to reduce newborn mortality in low resource countries.