Résumé
<B>Objectives</B><BR>The objective of this study is to find the easily measurable associated factor for hypothermic neonatal mortality in a regional Moroccan hospital.<BR><B>Methods</B><BR>A retrospective study was carried out in PAGNON hospital. 52 patients admitted to PAGNON hospital neonatal unit for hypothermia between October 1st, 2005, and June 30, 2007, were included in this study. Clinical features including gestational age, body weight at hospitalization, rectal temperature, the day after birth, place of delivery were recorded at the time of hospitalization. Hypothermia was classified as per WHO classification.<BR><B>Results</B><BR>In 52 hypothermic neonates, 36 patients (69.3%) survived and 16 patients (30.7%) died. There was a significant statistical difference between survival group and no survival group regarding rectal temperature (31.1±2.7°Cvs. 28.7±2.3°C; mean±SD, p=0.003). All patients who died during hospitalization had below 33°C of rectal temperature at hospitalization. As for WHO classification, the severe hypothermic group had higher mortality rate than the moderate hypothermic group (45.2% vs. 9.5%, p=0.006). There was no significant statistical difference for body weight at hospitalization, the day after birth and gestational age in two groups. The severe hypothermic group was higher in the ratio of delivery at the domicile than those of moderate hypothermic group (22.6% vs. 0%, p=0.020). In multiple logistic regression analysis accounting for rectal temperature, the day after birth and body weight at hospitalization, only rectal temperature was significantly associated with survival rate (odds ratio 1.408, 95% confidence interval 1.088−1.821, p=0.009).<BR><B>Conclusion</B><BR>Between the moderate hypothermic neonates and the severe hypothermic neonates classified WHO classification, there was a significant difference between the mortality rate. It is important to keep the rectal temperature more than 32°C. The rectal temperature is an associated factor for hypothermic neonatal mortality which is easily measured at hospitalization in rural hospital in morocco.
Résumé
The prospective study was undertaken to observe the pattern of fall in the rectal temperature that occurred in neonates after birth and to determine the birth rectal temperature, the relationship of birth temperature between mothers and babies and the effect of measures minimizing body heat loss on the prevention of neonatal hypothermis in the delivery room. The measure given were placing a radiant warmer close to the mother’s lower extremities to provide a higher thermal environment for the neonate before the anticipated time of delivery, drying the neonate immediately after birth with a prewarmed dry towel, placing it under a preheated overhead rediant warmer from the time it was moved to the bathing area to the time being transferred to the nursery. Rectal temperatures were taken immediately after birth, immediately transferred to the bathing area, after cleaned and on admission to the nursery. Three groups, each of 37 infants, of term infants with normal deliveries and with Apgar scores of > 8 were studied. Infants in group 1 receiving routine care provided in the delivery room were observed for the fall in the rectal temperature. Those in group 2 and 3 were studied to evaluate the effect of measures minimizing body heat loss on the prevention of hypothermia: group 2 received only routine care; group 3 received both routine care and the measures minimizing heat loss. The mean birth rectal temperature was 37.6+0.5 oC (range 36.7 – 39.1). The correlation coefficient of the relationship between the birth and temperatures of mothers and babies was 0.61 (p = 0.01). Under routin care newborns lost heat rapidly at birth and during the period they were in the delivery room. Washing soon 5 – 20 minutes after birth caused a rapid fall in body temperature. By 18.7 mins after birth the mean rectal temperature was 36.4 oC and at a mean age of 68.5 mins 95% of the neonates had hypothermia. Swaddling neonates with towel could not prevent body heat loss. The fall in body temperature that occurred in group 3 was significantly less when compared to group 2 and non in group 3 suffered from hypothermia. This study demonstrates that efforts to limit heat loss should be concentrated immediately after birth and on the practice of cleaning neonates in the delivery room. Measures minimizing heat loss can effectively prevent hypothermia in the dilvery room.