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Open Access Research article

The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival

Karsten Lunze1*, David E Bloom2, Dean T Jamison3 and Davidson H Hamer45

Author affiliations

1 Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2077, Boston, Massachusetts 02118, USA

2 Department of Global Health and Population, 665 Huntington Avenue, Building I 12th Floor, Boston, Massachusetts 02115, USA

3 Department of Global Health, University of Washington, 325 9th Avenue, Ste. 359931, Seattle, WA 98104, USA

4 Department of International Health and Medicine, Boston University Schools of Public Health and Medicine, 801 Massachusetts Avenue, Boston, Massachusetts 02118, USA

5 Zambia Centre for Applied Health Research and Development, 4649 Beit Road, Lusaka, Zambia

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Citation and License

BMC Medicine 2013, 11:24  doi:10.1186/1741-7015-11-24

Published: 31 January 2013

Abstract

Background

To provide evidence on the global epidemiological situation of neonatal hypothermia and to provide recommendations for future policy and research directions.

Methods

Using PubMed as our principal electronic reference library, we searched studies for prevalence and risk factor data on neonatal hypothermia in resource-limited environments globally. Studies specifying study location, setting (hospital or community based), sample size, case definition of body temperature for hypothermia, temperature measurement method, and point estimates for hypothermia prevalence were eligible for inclusion.

Results

Hypothermia is common in infants born at hospitals (prevalence range, 32% to 85%) and homes (prevalence range, 11% to 92%), even in tropical environments. The lack of thermal protection is still an underappreciated major challenge for newborn survival in developing countries. Although hypothermia is rarely a direct cause of death, it contributes to a substantial proportion of neonatal mortality globally, mostly as a comorbidity of severe neonatal infections, preterm birth, and asphyxia. Thresholds for the definition of hypothermia vary, and data on its prevalence in neonates is scarce, particularly on a community level in Africa.

Conclusions

A standardized approach to the collection and analysis of hypothermia data in existing newborn programs and studies is needed to inform policy and program planners on optimal thermal protection interventions. Thermoprotective behavior changes such as skin-to-skin care or the use of appropriate devices have not yet been scaled up globally. The introduction of simple hypothermia prevention messages and interventions into evidence-based, cost-effective packages for maternal and newborn care has promising potential to decrease the heavy global burden of newborn deaths attributable to severe infections, prematurity, and asphyxia. Because preventing and treating newborn hypothermia in health institutions and communities is relatively easy, addressing this widespread challenge might play a substantial role in reaching Millennium Development Goal 4, a reduction of child mortality.

Keywords:
hypothermia; mortality; neonatal; newborn; prematurity