Hypothermia in preterm infants admitted to low-resource neonatal units in northern Nigeria: an observational study of occurrence and risk factors.

BACKGROUND: Hypothermia is an important cause of morbidity and mortality among preterm and low-birth-weight neonates. In resource-constrained settings, limited referral infrastructure and technologies for temperature control potentiate preterm hypothermia. While there is some documentation on point-of-admission hypothermia from single center studies, there are limited multicenter studies on the occurrence of hypothermia among preterm infants in resource-limited-settings. Therefore, we conducted a multicenter study to determine the prevalence and risk factors for hypothermia at the time of admission and during the first 72 h after admission in northern Nigeria. METHOD: We carried out a prospective cohort study on preterm infants admitted to four referral hospitals in northern Nigerian between August 2020 and July 2021. We documented temperature measurements at admission and the lowest and highest temperatures in the first 72 h after admission. We also collected individual baby-level data on sociodemographic and perinatal history data. We used the World Health Organization classification of hypothermia to classify the babies' temperatures into mild, moderate, and severe hypothermia. Poisson regression analysis was used to identify risk factors for moderate-severe hypothermia. RESULTS: Of the 933 preterm infants enrolled, 682 (72.9%) had hypothermia at admission although the prevalence of hypothermia varied across the four hospitals. During the first 24 h after admission, 7 out of every 10 babies developed hypothermia. By 72 h after admission, between 10 and 40% of preterm infants across the 4 hospitals had at least one episode of moderate hypothermia. Gestational age (OR = 0.86; CI = 0.82-0.91), birth weight (OR = 8.11; CI = 2.87-22.91), presence of a skilled birth attendant at delivery (OR = 0.53; CI = 0.29-0.95), place of delivery (OR = 1.94 CI = 1.13-3.33) and resuscitation at birth (OR = 1.79; CI = 1.27-2.53) were significant risk factors associated with hypothermia. CONCLUSION: The prevalence of admission hypothermia in preterm infants is high and hypothermia is associated with low-birth-weight, place of delivery and presence of skilled birth attendant. The prevalence of hypothermia while in care is also high and this has important implications for patient safety and quality of patient care. Referral services for preterm infants need to be developed while hospitals need to be better equipped to maintain the temperatures of admitted small and sick newborns.

Facility-Based Newborn Deaths at a Referral Tertiary Hospital in North-Central Nigeria during the Sustainable Development Goal Era: A Retrospective Cohort Analysis.

BACKGROUND: Nigeria has the largest number of global under-five deaths and almost half of these occur in the newborn period in an almost 50:50 ratio across hospital facilities and communities. We examine and describe risk factors for newborn mortality at a busy neonatal unit of a referral tertiary hospital in North-central Nigeria. METHODS: We conducted a retrospective cohort analysis of all newborn admissions to the Dalhatu Araf Specialist Hospital between September 2018 and March 2020. We determined the newborn mortality rate (NMR) and case fatality rates (CFRs) for individual diagnostic categories and determined risk predictors for mortality using cox-proportional hazard models. RESULTS: Of 1171 admitted newborn infants, 175 (14.9%) died with about half of these occurring within 24 h of admission. Extremely low birth weight infants and those with congenital anomalies had the highest CFRs. Identified risk factors for mortality were age at admission [adjusted hazard ratio (AHR): 0.996, 95% CI: 0.993-0.999], admitting weight (AHR: 0.9995, 95% CI: 0.9993-0.9997) and home delivery (AHR: 1.65, 95% CI: 1.11-to 2.46). CONCLUSIONS: Facility-based newborn mortality is high in North-central Nigeria. Majority of these deaths occur within the first 24 h of admission, signifying challenges in acute critical newborn care. To improve the current situation and urgently accelerate progress to meet the sustainable development goal NMR targets, there is an urgent need to develop human and material resources for acute critical newborn care while encouraging facility-based delivery and decentralizing existing newborn care. Lay summaryNigeria now has the greatest number of deaths in children below the age of five globally. Almost half of these occurred in the newborn period and these deaths occur within hospital facilities and also in communities in an almost 50:50 ratio. As such, the country might not attain global newborn mortality rates that were set as targets for the sustainable development goals (SDGs). In this article, we examine and describe the risk factors for newborn deaths occurring at a typical newborn unit in North-central Nigeria. During the period under review, we found that about 175 (14.9%) died and about half of these deaths occurred within 24 h of admission. Extremely small babies and those who were born with physical defects had the highest death rates. Older babies and those who weighed more at admission had decreased risks of dying while being delivered at home increased the risk of death. Hospital newborn deaths remain high in North-central Nigeria and the pattern of early admission deaths signifies challenges in stabilizing critically ill newborn infants. There is an urgent need to develop human and material resources for acute critical newborn care while encouraging institutional delivery and decentralizing of existing newborn care.