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Table 1 Global epidemiology of newborn hypothermia

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

Reference Location Setting N Case definition body temp Temperature measurements Hypothermia prevalence Additional findings
Africa
Hospital based:
[28] Sagamu, Nigeria University Hospital 150 < 36.5°C Axillary upon admission 62% Hypothermia risk highest in the first 24 h of life in preterm babies
[75] Sagamu, Nigeria University Hospital 111 < 36.5°C Axillary upon admission 68% Hypothermia risk highest in low birth weight babies and those who were not breastfed
[76] Ibadan, Nigeria University Hospital 541 < 35.0°C N/A 45% Hypothermia more prevalent on admission in infants born outside the hospital than those born at the hospital
[35] Guinea-Bissau National Hospital 2,926 < 34.5°C Axillary within 12 h of birth 8% Hypothermia of < 34.5°C associated with mortality risk of 4.81 (95% CI 2.90 to 8.00) in first 7 days compared to those without hypothermia
[29] Kampala, Uganda Periurban Hospital 300 < 36.5°C Rectal and tympanic four times within 90 minutes postpartum 79% Hypothermia incidence increased from 29% at 10 minutes postpartum to 79% at 90 minutes postpartum
[47] Kampala, Uganda Periurban Hospital 249 < 36.5°C Rectal 60 minutes postpartum 46% Early bathing increased the risk of hypothermia in spite of use of warm water and skin-to-skin care
[25] Lusaka, Zambia University Hospital 62 < 36.0°C Rectal 30 and 120 minutes after delivery 53% and 69% At discharge after an average of 14 h, hypothermia was still persistent in half of all babies sampled
[26] Lusaka, Zambia University Hospital 261 < 36.0°C Rectal upon admission 44% Mortality was higher in hypothermic infants than in those who were not hypothermic
[77] Harare, Zimbabwe University Hospital 313 < 36.0°C Axillary 51.4%  
[59] Harare, Zimbabwe University Hospital 313 < 36.0°C Axillary upon admission 85%  
[27] Ethiopia Hospital   < 36.0°C N/A 53%  
Asia
Hospital based:
[78] Iran, different provinces University Hospitals 1,952 < 36.0°C Rectal after delivery and four repeats within 6 h of admission to neonatal unit 33.8% Newborn with low birth weight, prematurity, low Apgar scores, of multiple pregnancies and after cardiopulmonary resuscitation at higher risk for being hypothermic in regression analysis. Hypothermia is associated with an increased risk of neonatal mortality risk (OR = 3.1, 95% CI 1.9 to 5.2) as well as risk of metabolic acidosis, jaundice, respiratory distress, hypoglycemia, and pulmonary hemorrhage.
[33] Tehran, Iran University Hospitals 940 < 36.5°C Rectal upon admission to neonatal unit (mean time after delivery 20 minutes) 53.5% Hypothermia at birth is associated with an increased neonatal mortality risk (OR = 3.64, 95% CI 1.85 to 7.18), as well as risk for respiratory distress (OR = 2.12, 95% CI 1.53 to 2.93), metabolic acidosis (OR = 2.83, 95% CI 1.74 to 4.59), and jaundice (OR = 2.01, 95% CI 1.45 to 2.79), controlling for weight and gestational age
[32] Tehran, Iran University Hospital 900 < 36.5°C Rectal after delivery and four repeats within 6 h of admission to neonatal unit 53.3% Low birth weight, low gestational, age environmental temperature, low Apgar score, multiple pregnancy and receiving cardiopulmonary resuscitation increased risk for being hypothermic in regression analysis
[79] Hangzhou, China University Hospital 200 < 36.5°C Axillary after delivery and five times on first, second and third day 52% Hypothermia risk associated with low birth weight and gestational age
[40] Kathmandu, Nepal Maternity Hospital 495 < 36.0°C Rectal 2 h after delivery 85%  
[80] Kathmandu, Nepal Maternity Hospital 82 < 35.0°C Rectal after delivery 26%  
[60] Kathmandu, Nepal Maternity Hospital 100 < 36.0°C Rectal after delivery 64% 16% of hypothermic infants died within first week of life
[81] Kathmandu, Nepal Maternity Hospital 76 < 36.0°C Axillary after delivery 63%  
[82] Kathmandu, Nepal Maternity Hospital 35 < 36.0°C Continuous axillary and forehead skin probe 72% (Incidence in percent of time being hypothermic from birth to 8 h of life)  
[83] Mumbai, India Hospital 206 N/A N/A 37% Prevalence 5.9% in infants with kangaroo mother care
Asia
Community based:
[19] Kathmandu, Nepal Community 12 < 35.0°C Rectal within 12 h after delivery 91%  
[84] Kathmandu, Nepal Community 250 < 36.0°C Axillary 82%  
[20] Haryana, India Community 189 < 35.6°C Axillary once on first day 11% Higher prevalence in winter (19%) than in summer (3%); in a secondary analysis applying a case definition of 36.5°C, prevalence was 38%; correlation between room air temperature and body temperature
[21] Gadchiroli Community 763 < 35.0°C Axillary on 8 days during first month 17% Higher prevalence in winter than in summer
[22] Uttar Pradesh, India Community 1,732 < 36.5°C Axillary 3 to 36 h after birth 43% Body temperature lower in low ambient temp < 20°C and in newborns with hypothermic mothers
[85] Dehli, India Community 32 < 35.0°C Axillary daily on first 7 days of life 25%  
[39] Uttar Pradesh, India Community 148 < 36.5°C Axillary within 48 h and on days 7, 30 and 60 14%  
[16] Sarlahi, Nepal Community 23,240 < 36.5°C Axillary on 10 days during first month 92.3% Hypothermia risk highest in the first 72 h of life
[17] Sarlahi, Nepal Community 23,240 < 36.5°C Axillary on 10 days during first month 92.3% Hypothermia risk highest in preterm babies, females, those breastfed later than 24 h after delivery, and those with hypothermic mothers
[18] Sarlahi, Nepal Community 23,240 < 36.5°C Axillary on 10 days during first month 92.3% Mortality risk increases by 80% for every 1°C decrease. Mortality risk 6.11 for newborns < 35.0°C compared to those > 36.5°C.
South America
Hospital based:
[34] Recife, Brazil University Hospital 320 < 36.5°C Axillary on admission 32% Hypothermia increased neonatal mortality risk, AOR = 3.49, 95% CI 3.18 to 3.81