MAINTENANCE OF WARM CHAIN FOR NEWBORNS: THE MISSING STEP.�Machakos County Referral Hospital, Kenya �����

JACINTA MOKI: BSCN, MSC. NURSING(ongoing)

MIRIAM MUNYALO: KRCHN,KRPN

INTRODUCTION

Background

• Hypothermia in newborns is defined as a core body temperature below 36.5°C (97.7°F) (WHO, 2023).
• Ranges from mild (36-36.4°C), moderate (32-35.9°C), to severe (<32°C) (WHO, 2023).
• It can lead to decreased oxygen delivery, hypoglycemia, and metabolic acidosis
• Moreover prolonged hypothermia can impair the body's ability to regulate temperature, leading to a vicious cycle of heat loss (Lunze et al., 2022).
• In addition hypothermia has been associated with an increased risk of respiratory distress syndrome and other respiratory complications (Ogunlesi & Ogunfowora, 2021).
• Survivors of neonatal hypothermia may experience long-term developmental delays and disabilities (Lunze et al., 2022).

INTRODUCTION…

Background

• Neonatal hypothermia is a major cause of morbidity and mortality globally
• It is a significant public health concern, particularly in resource-limited regions (World Health Organization , 2023)
• Estimated 32 million newborns experience hypothermia each year globally (WHO, 2023)
• Prevalence is particularly high in low- and middle-income countries, ranging from 32% to 85% (Lunze et al., 2022)
• Estimates suggest neonatal hypothermia contributes to over 400,000 neonatal deaths annually worldwide (WHO, 2023)

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INTRODUCTION…

Background

• Across sub-Saharan Africa, the prevalence of neonatal hypothermia is estimated to range from 32% to 85% (Lunze et al., 2022)
• Contributing factors include inadequate healthcare infrastructure, limited access to warming devices, and cultural practices (Lunze et al., 2022)
• A 2018 systematic review and meta-analysis reported a pooled prevalence of 21.7% for neonatal hypothermia in Kenya.
• Risk factors include preterm birth (70% prevalence) and low birth weight (77% prevalence) (Maina et al., 2021)
• Only 17% of healthcare facilities in Nairobi had adequate equipment and supplies to manage neonatal hypothermia (Bakeera-Kitaka et al., 2022)
• In Machakos county 25% of neonates were hypothermic on admission to the NBU (NESTIT360,2023)

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• The warm chain concept
• Warmth at birth place
• Warmth during transport
• Warmth in the hospital /home

OBJECTIVE

• This retrospective study aimed to evaluate the missed steps in the maintenance of warm chain for newborns at admission at Machakos County Referral Hospital

METHODS

• Observational and Retrospective methods were utilized
• Non-participant observation using a structured observation checklist was done by a nurse at different shifts in the labor ward, maternity theatre and the New Born Unit fora period of 1month
• The checklist was drafted by NEST360 having noted the high numbers of hypothermic babies

in most of the facilities they are implementing a project on quality of care among the neonates.

• The checklist comprised of different sections on prevention of hypothermia; at birth, during transportation, at admission to NBU and the neonates stay in NBU

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RESULTS

It was observed that:

At birth and within 1 hour of delivery

• Babies were not completely dried
• Skin to skin was not practiced
• The newborns heads were not covered with hats immediately after they were prewarmed
• During resuscitation some babies were exposed
• Weighing was not delayed for some babies

At admission to NBU

• Some of the staff in the newborn unit unwrapped the neonates immediately at admission to the unit.

BEFORE OBSERVATION

AFTER T OBSERVATION AND INTERVENTION

CONCLUSION

• Though much improvement has been recorded in the reduction of hypothermic cases among newborns at admission, there is a need for optimal adherence to the ten-warm chain steps to ensure all neonates are warm at admission for their survival .

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RECOMMENDATIONS

• Regular audit of the processes of care of the small and sick neonates in order to identify the actual gaps and specifically address them

IMPLICATIONS TO POLICY

• The application of the warm chain guidelines must be optimized during the implementation of continuous quality improvement interventions to address neonatal hypothermia.
• The guidelines on warm chain must therefore be available and accessible to all staff involved in care of small and sick newborns either directly or indirectly.

References

1. Mwaniki, P. K., Gatakaa, H. W., Mwarumba, S., Nzyuko, S. M., Sande, J. H., Maitha, G. M., ... & English, M. (2020). Evaluation of a novel bundle of interventions to improve the management of neonatal hypothermia in rural Kenya.
2. Okwaro, F. A., Oyugi, B. O., Akech, S. O., Mwaniki, P. K., & English, M. (2021). Determinants of neonatal hypothermia among preterm infants admitted to a Kenyan hospital
3. Maina, M. N., Wamae, A., Aluvaala, J., Mwaniki, P., Ogero, M., Muraya, K., ... & English, M. (2021). Effectiveness of a bundled intervention to improve the management of neonatal hypothermia in rural Kenyan hospitals
4. Shikuku, D. N., Milimo, B., Ayebare, E., Gisore, P., & Nalwadda, C. (2018). Practice and factors associated with newborn thermal care handling in Kakamega County, western Kenya.
5. Gisore, P., Shipala, E., Otieno, K., Rono, B., Marete, I., Tenge, C., ... & Liechty, E. A. (2013). Community based weight monitoring to address low birth weight in rural Kenya. BMC Pregnancy and Childbirth, 13(1), 1-8. https://doi.org/10.1186/1471-2393-13-8

Refences

6.Wondmieneh, A., Gedefaw, G., Fetene, G., & Tsegaw, A. (2021). Prevalence and associated factors of neonatal hypothermia among neonates admitted to the neonatal intensive care unit at the University of Gondar

7.Abraha, M. W., Abrha, M. W., Gebregiorgis, Y. S., Tsegay, L., Weldegebriel, B. T., Hadgu, F. B., & Tsegaye, A. T. (2021). Magnitude and associated factors of neonatal hypothermia among neonates admitted to neonatal intensive care unit of Aksum University

8.Belay, M. T., Getachew, T., Fisseha, H. Z., Abera, G. B., & Gebremedhin, M. (2022). Prevalence and associated factors of neonatal hypothermia among neonates admitted to neonatal intensive care unit of Mekelle University Comprehensive Specialized Hospital, northern Ethiopia

9.Weldegebriel, B. T., Gebremedhin, M., Belay, M. T., & Fisseha, H. Z. (2022). Neonatal hypothermia and associated factors among neonates admitted to neonatal intensive care unit of Suhul General Hospital, northern Ethiopia

10Worku, T. K., Worku, E., & Gizaw, M. (2021). Prevalence and associated factors of neonatal hypothermia among neonates admitted to neonatal intensive care unit of Debre Berhan Referral Hospital, North Shoa, Ethiopia