Hypothermia as a Predictor of Adverse Outcomes in Sick Neonates Referred to a Tertiary Care NICU
Aswathy Rahul, Vidhukumar Karunakaran, Athira Rani Muralidharan Rohini, Radhika Sujatha, Rajamohanan Kunjukrishnapillai
Abstract
Background: Addressing the preventable causes of neonatal mortality and morbidity will help achieve the sustainable development goal target of neonatal mortality rate and other childhood mortality rates. Hypothermia is one such cause, and its relation to morbidity has not been established.
Aim: To determine whether moderate-to-severe hypothermia is a significant predictor of adverse neonatal outcomes, and to develop a best-fitting predictive model for adverse neonatal outcomes
Materials and Methods: This prospective, analytical study was conducted in the outborn nursery of Government Medical College (Thiruvananthapuram, Kerala, India) from January 2022 to August 2022. All the sick neonates born after 28 weeks of gestation were consecutively enrolled. The temperature and other potential predictor variables at admission were analyzed for their association with the composite outcome of abnormal findings on neurological examination or mortality.
Results: Among the 496 sick neonates analyzed, 115 (23.2%) neonates had moderate-to-severe hypothermia at admission, and 47 (9.5%) neonates had adverse outcomes. Univariate analysis showed that moderate-to-severe hypothermia had a relative risk of 3.46 (CI: 2.03–5.89) and an attributable risk of 14.83% for the adverse outcomes, and it was a significant predictor after adjusting for other potential confounders (adjusted OR: 2.8; CI: 1.18–6.67). The best-fitting model had 6 predictors namely moderate-to-severe hypothermia, hypoxia, congenital disorders, severe meconium aspiration syndrome and/or persistent primary pulmonary hypertension, hypoxic-ischemic encephalopathy stages 2 and 3, and prematurity.
Conclusions: Hypothermia is still an underrecognized problem during the transport of neonates, and it is a significant predictor of adverse neonatal outcomes.
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