Muhindo Mary Kakuru, Bress Joshua, Armas Jean, Danziger Elon, Wu Andrew, Brewster Ryan C L
Infectious Diseases Research Collaboration, Kampala, Uganda.
Global Strategies, Albany, California, United States of America.
PLOS Glob Public Health. 2023 Feb 9;3(2):e0000982. doi: 10.1371/journal.pgph.0000982. eCollection 2023.
Hypothermia (axillary temperature less than 36.5°) is a major source of neonatal morbidity and mortality, with a disproportionate burden of disease in low- and middle-income countries. Despite the importance of thermoregulation on newborn outcomes, the global epidemiologic landscape of neonatal hypothermia is poorly characterized. Clinical decision support (CDS) software provides point-of-care recommendations to guide clinical management and may support data capture in settings with limited informatics infrastructure. Towards this end, we conducted a prospective observational study of the NoviGuide, a novel CDS platform for newborn care, at four health facilities in Uganda between September 2022 to May 2021. Data were extracted from clinical information (e.g. axillary temperature, birth weight, gestational age) entered into the NoviGuide by nurses and midwives on newborns within 24 hours of delivery. Descriptive statistics and multivariable logistic regression were used to evaluate neonatal temperature profiles and the association between hypothermia and clinical features. Among 1,027 completed assessments, 30.5% of entries had neonatal hypothermia with significant variation across study sites. On multivariable logistic regression analysis, we found that hypothermia was independently associated with pre-term birth (Adjusted Odd's Ratio [aOR] 2.62, 95% Confidence interval [CI] 1.38-4.98), sepsis/concern for sepsis (aOR 2.73, 95% CI 2.90-3.94), and hypoglycemia/concern for hypoglycemia (aOR 1.78, 95% CI 1.17-2.72). Altogether, neonatal hypothermia was commonly entered into the NoviGuide and associated clinical characteristics aligned with previous studies based on conventional data collection instruments. Our results should be contextualized within unique technical and operational features of CDS tools, including a bias towards acutely ill patients and limited quality control. Nonetheless, this study demonstrates that a CDS used voluntarily by clinicians has the potential to fill key data gaps and drive quality improvement towards reducing neonatal hypothermia in low resource settings.
体温过低（腋温低于36.5°）是新生儿发病和死亡的主要原因，在低收入和中等收入国家疾病负担尤为严重。尽管体温调节对新生儿结局很重要，但全球新生儿体温过低的流行病学情况仍缺乏充分描述。临床决策支持（CDS）软件可提供即时护理建议以指导临床管理，并可能在信息学基础设施有限的环境中支持数据收集。为此，我们于2022年9月至2021年5月在乌干达的四个医疗机构对NoviGuide（一种用于新生儿护理的新型CDS平台）进行了一项前瞻性观察研究。数据从护士和助产士在分娩后24小时内输入NoviGuide的临床信息（如腋温、出生体重、胎龄）中提取。使用描述性统计和多变量逻辑回归来评估新生儿体温情况以及体温过低与临床特征之间的关联。在1027项完成的评估中，30.5%的记录显示新生儿体温过低，各研究地点之间存在显著差异。在多变量逻辑回归分析中，我们发现体温过低与早产独立相关（调整后的比值比[aOR]为2.62，95%置信区间[CI]为1.38 - 4.98）、败血症/疑似败血症（aOR为2.73，95%CI为2.90 - 3.94）以及低血糖/疑似低血糖（aOR为1.78，95%CI为1.17 - 2.72）。总体而言，新生儿体温过低情况普遍记录在NoviGuide中，相关临床特征与以往基于传统数据收集工具的研究一致。我们的结果应结合CDS工具独特的技术和操作特点来考量，包括对急重症患者的偏向性以及有限的质量控制。尽管如此，本研究表明临床医生自愿使用的CDS有潜力填补关键数据空白，并推动在资源匮乏地区降低新生儿体温过低方面的质量改进。
