RT Journal
A1 Mullany LC, Katz J, Khatry SK, LeClerq SC, Darmstadt GL, Tielsch JM
T1 RIsk of mortality associated with neonatal hypothermia in southern nepal
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 2010
FD July 1
VO 164
IS 7
SP 650
OP 656
DO 10.1001/archpediatrics.2010.103
UL http://dx.doi.org/10.1001/archpediatrics.2010.103
AB Objective 
    To quantify the neonatal mortality/hypothermia relationship and develop evidence-based cutoffs for global definitions of neonatal hypothermia.Design 
    Cohort study. Field workers recorded neonatal axillary temperature at home and recorded vital status at 28 days.Setting 
    Rural Nepal.Participants 
    Twenty-three thousand two hundred forty infants in Sarlahi, Nepal.Main Exposure 
    Hypothermia.Outcome Measures 
    Mortality risk was estimated using binomial regression models. Infants were classified using (1) World Health Organization (WHO) cutoffs for mild, moderate, and severe hypothermia; (2) quarter-degree intervals from 32.0°C to 36.5°C; and (3) continuous temperatures. Estimates were adjusted for age, ambient temperature, and other potential confounders.Results 
    Mortality increased among mild (relative risk [RR], 1.70; 95% confidence interval [CI], 1.23-2.35]), moderate (RR, 4.66; 95% CI, 3.47-6.24]), and severe (RR, 23.36; 95% CI, 4.31-126.70]) hypothermia cases. Within the WHO's moderate classification, risk relative to normothermic infants ranged from 2 to 30 times. Adjusted mortality risk increased 80% (95% CI, 63%-100%) for each degree decrease, was strongly associated with temperatures below 35.0°C (RR, 6.11; 95% CI, 3.98-9.38), and was substantially higher among preterm infants (RR, 12.02; 95% CI, 6.23-23.18]) compared with full-term infants (RR, 3.12; 95% CI, 1.75-5.57). Relative risk was highest in the first 7 days, but remained elevated through 28 days.Conclusions 
    A new hypothermia classification system should be considered by the WHO for global guidelines. We recommend that grade 1 be equivalent to the current mild category (36.0°C), restricting and splitting the moderate category into grades 2 (35.0°C-36.0°C) and 3 (34.0°C-35.0°C), and expanding severe hypothermia to less than 34.0°C (grade 4). Reducing hypothermia may dramatically decrease the global neonatal mortality burden.