Prevalence and determinants of Neonatal hypothermia in a tertiary Hospital, Gondar Ethiopia: A cross-sectional study

doi:10.21203/rs.3.rs-4959607/v1

Download PDF

Article

Prevalence and determinants of Neonatal hypothermia in a tertiary Hospital, Gondar Ethiopia: A cross-sectional study

https://doi.org/10.21203/rs.3.rs-4959607/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Neonatal hypothermia is a significant global problem of neonates with huge contribution of neonatal morbidity and mortality. Recognizing major contributors of neonatal hypothermia is very important in designing preventing methods which was the objective of our study. This was an institution-based cross-sectional study conducted on 339 neonates admitted to Neonatal Intensive Care Unit of University of Gondar Comprehensive Specialized Hospital over 6months. Study participants were selected using systematic random sampling technique and both bivariate and multivariate logistic regression analyses were used to identify contributors and p-value of < 0.05 was considered statistically significant. In our study, prevalence of neonatal hypothermia was 70.05%. Low birth weight (AOR = 8.35, 95%CI: 2.34, 29.80), bathing with in 24 hour (AOR = 3.96, 95%CI: 1.06, 14.78), absence of head cover (AOR = 3.11, 95%CI: 1.16, 8.38), C/S delivery ( AOR = 8.54, 95%CI: 2.01, 36.39), night time delivery (AOR = 2.92, 95%CI: 1.29, 6.61) and being out born (AOR = 6.84, 95%CI: 2.12, 22.13) were having significant association with neonatal hypothermia. In this study; the Prevalence of neonatal hypothermia was significantly high and low birth weight, bathing within 24 hours ,absence of head cove ,C/S delivery, delivery at night and being out born were having significant association with neonatal hypothermia.

Neonatal

Hypothermia

Prevalence

Risk factors

Gondar

Neonatal hypothermia is defined by the World Health Organization (WHO) as core temperature below 36.5˚C (97.7˚F). The severity of neonatal hypothermia is classified as mild (36˚C-36.4˚C), moderate (32˚C-35.9˚C) or severe (< 32˚C) in which severity is having significant prognostic implications [1, 2]. A newborn cools down or heats up much faster and is able to tolerate only a limited range of environmental temperature due to less efficient body temperature regulatory mechanisms, Even though; the current global birth practices tendency is not adequately addressing the challenge, appropriate thermal protection of the newborn prevents hypothermia and its associated burden of morbidity and mortality[3]. WHO recognizes newborn thermal care as a critical and essential component of newborn care with a recommendation of a 10-step warm chain to prevent neonatal hypothermia: a warm delivery room, immediate drying, skin-to- skin contact, early and exclusive breast feeding, delayed bathing, appropriate clothing/bedding, keeping the baby with the mother, warm transportation and resuscitation, and training/raising awareness on the dangers of hypothermia [4]. Globally the magnitude of neonatal hypothermia ranges from 32–85% in those born in the hospital and 11–92% in home deliveries [5].The burden of neonatal hypothermia is found to be significant in sub-Saharan [6]. Globally, neonatal mortality is significantly related with neonatal hypothermia and common factors of neonatal hypothermia are: prematurity, low-birth weight, delayed breast feeding initiation within 1-hr of life, night-time delivery and neonatal health problems [7, 8].

Study design and Period

An institution-based cross-sectional study was conducted at Neonatal Intensive Care Unit of University of Gondar Comprehensive Specialized Hospital over 6-months (from March 1st -August 31st, 2023).

Study setting

The study was conducted at University of Gondar Comprehensive Specialized Hospital which is located 765 km northwest of Addis Ababa, the capital city of Ethiopia. It officially commenced its function in 1954 and it is now a tertiary teaching hospital that delivers health care services for more than 10 million population. It is the only hospital with level III NICU in the area that provides continuous life support and comprehensive care for high-risk neonates and those with complex and critical illnesses. The staff of NICU is composed of senior pediatricians, resident physicians, intern physicians and BSc nurses. On average; there are 225 admissions to NICU monthly according to the hospital monthly mortality and morbidity report.

Source and study population

The source populations were all neonates ever admitted and the study populations were those neonates admitted during the study period to NICU at UoGCSH.

Inclusion criteria

Neonates with birth weight ≥ 1000 gram or gestational age ≥ 28 weeks admitted during the study period were included in the study

Exclusion criteria

Neonates with major congenital anomalies which is incompatible to life were excluded

Sample size and sampling procedure

The sample size was be calculated using single population proportion formula by considering the following assumptions;95% CI, 5% margin of error and 69.8% proportion of neonatal hypothermia from a previous study conducted at NICU of University of Gondar Comprehensive Specialized Hospital [9].

N = Z²*P(1-p)/e²
N= (1.96)²x0.698 (1-0.698)/ (0.05)² = 324
By adding 5% non-respondent rate; the final sample size was 340.

The study participants were selected by using a systematic random sampling technique in order of admission registration which used every 4th fourth neonate (after we selected the 1st neonate by simple random sampling technique) until the required sample size was obtained.

Operational definitions

Hypothermia

Neonatal axillary temperature below 36.5˚C at admission to NICU

Early breast feeding

Initiation of breast feeding within one hour of delivery.

Data collection tools and procedures

Data were collected by treating physicians using a pre-tested structured and interviewer administered questionnaire after securing informed consent from a parent or legal guardian. The data collection tool (questionnaire) contains maternal and neonatal socio-demographic characteristics, obstetrics/ environmental factors and clinical conditions of the neonate which were developed by reviewing different literatures. Axillary temperature each participant was measured immediately at admission by a digital thermometer which measures between 32°C-42.9°C.

Data processing and analysis

Each filled questionnaire was double-checked for consistency and completeness before data entry. The refined data were entered into Epi Data V.4.6 and exported to STATA version 15.1 for cleaning and analysis. Prevalence of neonatal hypothermia was determined. Frequencies, Percentages, and mean were used to summarize descriptive statistics, and tables and figures were used for data presentation. To identify factors associated with neonatal hypothermia; first bi-variable logistic regression analysis was done on each independent variable and those variables with p-value < 0.2 were included in the multivariable logistic regression analysis. The strength of association was determined using an odds ratio and 95% confidence level. Statistical significance was stated at a P value of < 0.05.

Clinical characteristics of neonates

Majority, 196(57.8%) of the study participants were males, 70.2% of the neonates were term and 59.0% of them were having normal birth weight. Twenty nine (8.6%) of the neonates were bathed within 24 hour after delivery, breastfeeding within 1hr of delivery was initiated only for 36.6% of the neonates and majority (54.6%) of the neonates were identified to be inadequately clothed at admission and significant percentage (74.9%) were identified having no cap in the head. Thirty percent of neonates were delivered as preterm (GA < 37wks and majority (57.8%) of them were admitted at postnatal age of below 24hrs. Immediate skin-to-skin contact was done only for 28.6% and neonatal resuscitation was applied for 18.6% of the neonates. Among the participants, 78.8%, 20.6%, 15% and 10.6% were diagnosed to have neonatal sepsis, perinatal asphyxia, neonatal jaundice, and Respiratory Distress Syndrome (RDS), respectively (Table-1).

Table-1

Clinical characteristics of neonates (n = 339)

Characteristics			Frequency (n = 364)	Percentage (%)
Sex of the neonates
	Male		196	57.8
	Female		143	42.2
Birth weight
		< 2500 gram	139	41.0
		>=2500 gram	200	59.0
Gestational Age
		< 37 week	101	29.8
		>= 37 week	238	70.2
Age the neonate at admission
		< 24 hours	196	57.8
		≥ 24 hours	143	42.2
Bathing within 24 hours
		Yes	29	8.6
		No	310	91.4
Initiation of breastfeeding within one hour
		Yes	124	36.6
		No	215	63.4
Skin to skin contact after delivery
		Yes	97	28.6
		No	242	71.4
Neonatal Resuscitation(PPV/CPV)
		Done	63	18.6
		Not done	276	81.4
Clothing status at admission
		Well covered	154	45.4
		Poorly covered	185	54.6
Head Covered with cap
		Yes	85	25.1
		No	254	74.9
Other diagnosed neonatal health problems
		Neonatal Sepsis	267	78.8
		Perinatal Asphyxia	70	20.6
		Neonatal Jaundice	51	15.0
		Respiratory distress syndrome	36	10.6
		Hypoglycemia	35	10.3
		Meconium Aspiration Syndrome SyndromeAS	30	8.8
		Birth trauma	18	5.3
		Polycythemia	16	4.7

Maternal characteristics

More than half (52.8%) of the mothers were aged from 20-29yrs with the mean age of 26.5yrs. Significant majority (96.8%) of the mothers were married and nearly one-third (34.2%) of mothers didn’t attend formal education. Fifty two percent and 51.9% of the mothers were from urban areas and housewives, respectively (Table-2).

Table-2: Maternal characteristics (n = 339)

Characteristics		Frequency (n = 364)	Percentage (%)
Age in years
	15–19 years	20	5.9
	20–29 years	179	52.8
	≥ 30 years	140	41.3
Marital status
	Married	328	96.8
	Single	11	3.2
Educational status
	No formal education	116	34.2
	Elementary school	45	13.3
	High school	102	30.1
	College and above	76	22.4
Residence
	Urban	175	51.6
	Rural	164	48.4
Religion
	Orthodox Christian	282	83.2
	Muslim	45	13.3
	Protestant	12	3.5
Occupation status
	Government employee	85	25.1
	Private employee/business	63	18.6
	Farmer	15	4.4
	Housewife	176	51.9
Family Income
	< 5000 ETB	170	50.1
	>=5000 ETB	169	49.9

Obstetric characteristics

Majority (59.6%) of the pregnancies were multiparous. Three hundred nine (91.2%) of the mothers had at least one antenatal visit during this pregnancy and 88.8% of the pregnancies were singleton. Almost half (50.1%) of the deliveries were in the study hospital, 67.3% of the deliveries were SVD, 53.7% deliveries were registered to be in the night time and more than half (53.7%) of the mothers were diagnosed to have obstetrics related complications (Table-3).

Table-3: Obstetric characteristics of study participants (n = 339)

Characteristics			Frequency (n = 364)	Percentage (%)
Parity
	Primiparous		137	40.4
	Multiparous		202	59.6
ANC visit
		Yes	309	91.2
		No	30	8.8
Type of gestation
		Singleton	301	88.8
		Multiple	38	11.2
Mode of delivery
		SVD	228	67.3
		Instrumental assisted	39	11.5
		Cesarean section (C/S)	72	21.2
Place of delivery
		Inborn	170	50.1
		Out born	169	49.9
Time of delivery
		Day time	157	46.3
		Night time	182	53.7
Obstetric complication
		Yes	182	53.7
		No	157	46.3

Prevalence of neonatal hypothermia

The prevalence of neonatal hypothermia in newborns admitted to NICU at the University of Gondar Comprehensive Specialized Hospital was 70.5% (95%CI: 1.89, 3.02). Majority (60.7%) of the neonates was found to have moderate hypothermia and the remaining 34.7% and 4.6% of them were having mild and severe hypothermia, respectively.

Determinants of neonatal hypothermia

Multivariate logistic regression analysis indicated that neonates delivered out of the study hospital (AOR = 6.84, 95%CI: 2.12, 22.13), C/S delivery (AOR = 8.54,95%CI: 2.01,36.39), night time delivery (AOR = 2.92,95%CI: 1.29,6.61), birth weight below 2500 gram (AOR = 8.35,95%CI:2.34,29.80), early bathing within 24 hour (AOR = 3.96,95%CI: 1.06,14.78), poorly clothed at admission (AOR = 6.48, 95%CI: 2.57,16.29), and absence of head Cover with cap (AOR = 3.11,95%CI:1.16,8.38) were significantly associated with neonatal hypothermia with p-value < 0.05(Table-4).

Table 4

Bi-variate and multivariate logistic regression analyses on determinants of Neonatal Hypothermia (n = 339)
Variables	Category	Neonatal Hypothermia		COR (95%CI)	AOR (95% CI)	P-value	Sig
Variables	Category	Yes (239)	No (100)	COR (95%CI)	AOR (95% CI)	P-value	Sig
Maternal Residence	Urban	112	63	1	1
Maternal Residence	Rural	127	37	1.93(1.20, 3.12)	1.05(0.27, 4.08)	.94
Family Income	< 5000 ETB	130	40	1.79(1.11, 2.87)	0.36(0.09, 1.38)	.136
Family Income	>=5000 ETB	109	60	1	1
Birth weight	< 2500 gram	125	14	6.74(3.63, 12.51)	8.35(2.34, 29.80)	.001	*******
Birth weight	>=2500 gram	114	86	1	1
Gestational Age	< 37 week	94	7	8.61(3.83, 19.38)	1.75(0.38, 7.99)	.469
Gestational Age	>= 37 week	145	93	1	1
Resuscitation	Done	52	11	2.25(1.12, 4.52)	4.93(0.50, 48.49)	.171
Resuscitation	Not Done	187	89	1	1
Skin to Skin contact	Yes	48	49	1	1
Skin to Skin contact	No	191	51	3.82(2.31, 6.33)	0.97(0.35, 2.70)	.947
Early Breast feeding	Yes	57	67	1	1	.
Early Breast feeding	No	182	33	6.48(3.89, 10.82)	0.67(0.23, 1.92)	.455
Early Bathing	Yes	24	5	2.12(0.79, 5.73)	3.96(1.06, 14.78)	.041	**
Early Bathing	No	215	95	1	1
Head Coverage	Yes	31	54	1	1
Head Coverage	No	208	46	7.88(4.57, 13.58)	3.11(1.16, 8.38)	.025	**
Admission age	< 24 hours	151	45	1	1
Admission age	>= 24 hours	88	55	0.48(0.30, 0.76)	0.35(0.12, 1.02)	.054
Neonatal Sepsis	Yes	197	70	2.01(1.17, 3.46)	0.48(0.18, 1.27)	.14
Neonatal Sepsis	No	42	30	1	1
PNA	Yes	57	13	2.10(1.09, 4.03)	0.21(0.02, 1.96)	.171
PNA	No	182	87	1	1
Mode of Delivery	SVD	142	86	1	1
	Instrumental	34	5	4.12(1.55, 10.93)	1.91(0.53, 6.93)	.327
	C/S	63	9	4.24(2.01, 8.96)	8.54(2.01, 36.39)	.004	*******
Time of Delivery	Day time	86	71	1	1
Time of Delivery	Night time	153	29	4.36(2.63, 7.23)	2.92(1.29, 6.61)	.01	**
Admission time	Day time	141	91	1	1
Admission time	Night time	98	9	7.03(3.38, 14.61)	1.93(0.64, 5.81)	.241
Place of delivery	Inborn	112	58	1	1
Place of delivery	Out born	127	42	1.57(0.98, 2.51)	6.84(2.12, 22.13)	.001	*******
Prolonged labor (> 18 hour)	Yes	57	11	2.53(1.27, 5.07)	1.76(0.59, 5.27)	.312
Prolonged labor (> 18 hour)	No	182	89	1	1
/*Significant from multivariate logistic regression analysis

Neonatal hypothermia prevalence

In our study; the prevalence of neonatal hypothermia at admission was found to be 70.5% (95%CI: 1.89, 3.02). This result is in line with reports from Gondar, Dessie and Harar,Ethiopia where the prevalence of neonatal hypothermia at admission was found to be 69.8%, 66.8% and 66.3%, respectively [9–11]. Studies from Rwanda and Addis Ababa, Ethiopia also reported almost similar prevalence of 65.3% and 64%, respectively [12, 13]. However, the prevalence of neonatal hypothermia in this study was higher than reports from Sidama, Ethiopia, Uganda and Nigeria where the prevalence of Neonatal hypothermia was 51.8%, 51% and 42.2%, respectively [14–16]. In comparison with our study result, a significantly lower prevalence (17.1%) was reported from a Californian study, USA [17]. A prospective study from Kenya reported a significantly higher (73.7%) prevalence than our finding [18].

These significant variations can be explained by the differences is socioeconomic and cultural related factors in which maternal behavioral factors like immediate care as proper wrapping, skin to skin contact, putting cap to the baby, and early initiation of breastfeeding within one hour of birth and weather conditions will have significant effect on the magnitude of neonatal hypothermia. Additionally; differences in study design, study setting and season of the study can have effects on neonatal hypothermia.

Factors associated with Neonatal hypothermia at admission

In this study, there was a statistically significant association between neonatal hypothermia and birth weight below 2500 gram. Neonates with birth weight below 2500gram were 8.3 times (AOR: 8.35; 95%CI: 2.34, 29.80) more likely to develop neonatal hypothermia than those with a birth weight 2500 gram or more. This finding is consistent with reports from Gondar, Rwanda, Arbaminch and California where a neonate being low birth weight is significantly associated with admission hypothermia [9, 12, 14, 18]. It is known that being low birth weight has reduced ability of thermogenesis due to ineffective shivering with low brown fat and also a low birth weight neonate is at risk of higher heat loss related to higher body surface area to weight and thin immature skin.

Head covering/cap wearing was significantly associated with neonatal hypothermia. Newborns who didn’t wear cap at admission were 3 times (AOR: 3.11; 95%CI: 1.16, 8.30) more likely to be hypothermic compared with their counterparts. The same findings are reported from Harar, Sidama, Kenya, West Shewa, and Addis Ababa showing that not having immediate head covering, no immediate skin to skin contact and inadequate clothing were risks of neonatal hypothermia [11, 13, 19–21].

Early bathing within 24hrs of delivery was also observed to be one of the significant contributors of neonatal hypothermia in our study where those neonates who were bathed within 24hrs of life were 4 times (AOR: 3.96; 95%CI: 1.06, 14.78) more likely to develop hypothermia when compared to those who had not been bathed within 24 hour of age. This finding was in line with other studies conducted in sub-Saharan Africa, Sidama and Tigray, [6, 14, 22]. This might occur because bathing newborns within 24 hour of age increases heat loss with evaporation, conduction, and convection due to the effect of the cold water and cold environment. Apart from total body exposure required during bathing, separation from the mother’s body contact can again increase the risk of hypothermia.

Regarding to the mode of delivery, newborns delivered with Cesarean Section (C/S) were 8.5 times (AOR: 8.54; 95%CI: 2.01, 36.39) more likely to develop neonatal hypothermia which is consistent with a study conducted at a tertiary hospital in South Africa where 41% of neonates born via Caesarean section had hypothermia at birth [23].This finding might be due to in most cases emergency Cesarean Section done in mothers came with possible obstetrics complications that may affect neonatal heat production. The other possible explanation might be heat loss during transportation since the Neonatal Intensive Care Unit relatively far from the delivery ward.

In this study, time of delivery was found to have a significant association with neonatal hypothermia. Neonates born during night time were 3 times (AOR: 2.92; 95%CI: 1.29, 6.61) more likely to develop neonatal hypothermia. Similar results were reported from studies conducted in Dessie, Bahirdar, Tigray and East Africa [10, 17, 23, 24]. This might happen due to temperature difference at night and daytime. The cold temperature during night time might increase heat loss and develop hypothermia. Additionally the work overload during night-time is not equal to the daytime that might affect application of warm chain.

Place of delivery was also having significant effect on neonatal hypothermia at admission in this study and neonates delivered out of the hospital were nearly 7 times (AOR: 6.84; 95%CI: 2.12, 22.13) more likely to develop neonatal hypothermia. This finding might be due to the fact that most of the neonates referred with possible neonatal health related problems and suboptimal thermal care practices. Studies from Uganda and Sub-Saharan Africa showed that home delivery was a significant risk of neonatal hypothermia [22, 24].

The prevalence of neonatal hypothermia in this study was significantly high and majority of the identified contributing factors were easily preventable.

Recommendations

We strongly recommend that warm chain should be strictly implemented in the NICU and night shift activities should be seen differently in relation to the prevention of neonatal hypothermia. We also recommend further studies especially qualitative once to assess the knowledge, attitude and practices of clinicians and health science students working/practicing in the delivery ward and NICU.

Limitations of the study

The study was done in a single center and only in one similar season which may add limitations. There may be intra-and inter-personal variations in measuring the temperature and also not using similar thermometers may have effects on the prevalence of neonatal hypothermia in our study.

ANC: Ante Natal Care

AOR: Adjusted Odds Ratio

CI: Confidence Intervals

COR: Crude Odds Ratio

C/S: Cesarean Section

NICU: Neonatal Intensive Care Unit

SPSS: Statistical Package for Social Science

SVD: Spontaneous Vertex delivery

UOGCSH: University of Gondar Comprehensive and Specialized Hospital

WHO: World Health Organization.

Acknowledgment

We are thankful to study participants and caretakers, data collectors, and clinical staffs working at the NICU for their cooperation.

Ethical approval and consent to participate

All the methods and procedures in this study were carried out in accordance with relevant guidelines and regulations.

Ethical clearance was obtained from the Institutional review board of college of medicine and health sciences, University of Gondar (Ref.no VP/RTT/05/894/2022). After securing the ethical clearance, all mothers/legal guardians were informed about the purpose of the study and their participation was voluntary. Verbal informed consent was received from all primary care takers (mothers/legal guardians).Name or any identifier of the participants was omitted from the questionnaire; instead, the medical record number and code given to the patient for the research purpose were used to ensure confidentiality. The information retrieved was used only for this study purpose and stored with password locked computer

Authors’ contributions

Mehretie Kokeb Alemu (MKA) and Addisu Ginbu Dubie (AGD) developed the draft of the proposal and performed data collection and supervision. Mehretie Kokeb Alemu, Addisu Ginbu Dubie and Geta Bayu Genet (GBG) participated in statistical analysis of the data and manuscript preparation. All authors read and approved the final manuscript.

Competing Interests: The authors declare that they have no competing interests.

Funding: The authors received no fund for this work

Availability of data and materials: Data is available from the corresponding author upon reasonable request.

Consent for publication: Not applicable

World Health Organization. Thermal Protection of the Newborn: a practical guide [Internet]. Maternal and Safe Motherhood Programme. 1997. p. 1–67. Available from: https://www.who.int/maternal_child_adolescent/documents/ws42097th/en/
Vilinsky A, Sheridan A. Hypothermia in the newborn: An exploration of its cause, effect and prevention. Br J Midwifery. 2014;22(8):557–62.
Lunze K, Hamer DH. Thermal protection of the newborn in resource-limited environments. J Perinatol. 2012;32(5):317–24.
Kumar V, Shearer JC, Kumar A, Darmstadt GL. Neonatal hypothermia in low resource settings: A review. J Perinatol.2009;29(6):401–12.
Lunze K, Bloom DE, Jamison DT, Hamer DH. The global burden of neonatal hypothermia: Systematic review of a major challenge for newborn survival. BMC Med. 2013;11(1).
Onalo R. Neonatal hypothermia in sub-Saharan Africa : A review. Niger J Clin Pract. 2016;16(2):129–38.
Frank Phoya,et.al. Association of Neonatal Hypothermia with Morbidity and Mortality in a Tertiary Hospital in Malawi. Journal of Tropical Pediatrics. 2020; 66 :470–478
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet . 2010;375(9730):1969–87.
Erekia Ebrahim TS. Proportion of Neonatal Hypothermia and Associated Factors among New-borns at Gondar University Teaching and Refferal Hospital, Northwest Ethiopia: A Hospital Based Cross Sectional Study. Gen Med Open Access. 2015;03(04):1–7.
Yitayew YA, Aitaye EB, Lechissa HW, Gebeyehu LO. Neonatal Hypothermia and Associated Factors among Newborns Admitted in the Neonatal Intensive Care Unit of Dessie Referral Hospital, Amhara Region, Northeast Ethiopia. Int J Pediatr (United Kingdom). 2020;2020.
Alebachew Bayih W, Assefa N, Dheresa M, Minuye B, Demis S. Neonatal hypothermia and associated factors within six hours of delivery in eastern part of Ethiopia: a cross-sectional study. BMC Pediatr. 2019;19(1):252.
Urubuto F, Agaba F, Choi J, Dusabimana R, Teteli R, Kumwami M, et al. Prevalence, risk factors and outcomes of neonatal hypothermia at admission at a tertiary neonatal unit, Kigali, Rwanda–a cross-sectional study. J Matern Neonatal Med. 2021;34(17):2793–800.
Feyisa GT, Kassa A, Amare B, Negese S, Tadese S, Wondimu MG, et al. A community-based cross-sectional study of neonatal hypothermia and its associated factors among neonates in Shebadino woreda, Sidama region, South Ethiopia. J Clin Pediatr Neonatol. 2024;4(1):1–13.
Tessema T, Asena TF, Alemayehu MM, Wube AM. Risk factors for neonatal hypothermia at Arba Minch General Hospital, Ethiopia. PLoS One. 2022;17(12 December):1–12.
Shanta Dangol Shrestha. Incidence of neonatal hypothermia and its association with low birth weight, preterm delivery, APGAR score and nursing care. Journal of Patan Academy of Health Sciences. 2019; 6(2):75-80.
Diala U, Kanhu P, Shwe D, Toma B. Prevalence and risk factors for admission hypothermia in neonates in a Tertiary Hospital in Jos, Nigeria. J Clin Neonatol. 2022;11(4):195.
Shibesh BF, Yalew WA, Beyene MB, Minyiwab GW. Determinants of neonatal hypothermia among neonates admitted to neonatal intensive care unit northwest, Ethiopia, case-control study. J Matern Neonatal Med. 2022;35(20):3903–8.
Rebecca Dang, et.al. Incidence of Neonatal Hypothermia in the Newborn Nursery and Associated Factors. JAMA Network Open. 2023;6(8):e2331011
Nyandiko WM, Kiptoon P, Lubuya FA. Neonatal hypothermia and adherence to World Health Organisation thermal care guidelines among newborns at Moi Teaching and Referral Hospital, Kenya. PLoS One. 2021;16(3):1–11.
Seifu B, Belema D, Mamo K, Bulto GA. Determinants of Neonatal Hypothermia Among Babies Born in Public Hospitals of West Shewa Zone of Oromia Regional State, Ethiopia: Unmatched Case–Control Study. Res Reports Neonatol. 2021;11:13–21.
Demissie et al. Neonatal hypothermia and associated factors among neonates admitted to neonatal intensive care unit of public hospitals in Addis Ababa, Ethiopia BMC Pediatrics. 2018; 18:263
Mukunya D, Tumwine JK, Nankabirwa V, Odongkara B, Tongun JB, Arach AA, et al. Neonatal hypothermia in northern uganda: A community-based cross-sectional study. BMJ Open. 2021;11(2):1–10.
Tasew H, Gebrekristos K, Kidanu K, Mariye T, Teklay G. Determinants of hypothermia on neonates admitted to the intensive care unit of public hospitals of Central Zone, Tigray, Ethiopia 2017: Unmatched case-control study. BMC Res Notes. 2018;11(1):1–6.
Beletew B, Mengesha A, Wudu M, Abate M. Prevalence of neonatal hypothermia and its associated factors in East Africa: A systematic review and meta-analysis. BMC Pediatr. 2020;20(1):1–14.

No competing interests reported.

Download PDF

Editorial decision: Revision requested
03 Oct, 2024
Reviews received at journal
24 Sep, 2024
Reviews received at journal
16 Sep, 2024
Reviewers agreed at journal
13 Sep, 2024
Reviewers agreed at journal
12 Sep, 2024
Reviewers invited by journal
12 Sep, 2024
Editor assigned by journal
12 Sep, 2024
Editor invited by journal
02 Sep, 2024
Submission checks completed at journal
02 Sep, 2024
First submitted to journal
22 Aug, 2024

You are reading this latest preprint version

Prevalence and determinants of Neonatal hypothermia in a tertiary Hospital, Gondar Ethiopia: A cross-sectional study

Status:

Version 1

Abstract

Introduction

Methods

Study design and Period

Study setting

Source and study population

Sample size and sampling procedure

Operational definitions

Data collection tools and procedures

Data processing and analysis

Results

Clinical characteristics of neonates

Maternal characteristics

Obstetric characteristics

Prevalence of neonatal hypothermia

Determinants of neonatal hypothermia

Discussion

Neonatal hypothermia prevalence

Factors associated with Neonatal hypothermia at admission

Conclusion

Recommendations

Limitations of the study

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1