Rwanda Paediatric Association, University of Rwanda, Rwanda Military Hospital, Rwanda.
Rwanda Biomedical Center, Ministry of Health, Rwanda.
Ann Glob Health. 2024 Jul 29;90(1):49. doi: 10.5334/aogh.4430. eCollection 2024.
Neonatal hypothermia is a major cause of preventable morbidity and mortality, especially among the world's poorest newborns. A heat-producing wrap is necessary when kangaroo mother care (KMC) is insufficient or unavailable, yet there is little published research on such wraps. The Dream Warmer is a wrap designed to complement KMC and has been extensively studied in formal research settings but not in real-world conditions. We used implementation science methodology to understand the safety, effectiveness, and functionality of the Dream Warmer (hereafter, "Warmer"); its effect on clinical workflows; its interaction with other aspects of care such as KMC; and the Warmer's reception by healthcare providers (HCPs) and parents. We conducted a prospective, interventional, one-arm, open-label, mixed-methods study in 6 district hospitals and 84 associated health centers in rural Rwanda. Our intervention was the provision of the Warmer and an educational curriculum on thermoregulation. We compared pre and post intervention data using medical records, audits, and surveys. The Warmer raised no safety concerns. It was used correctly in the vast majority of cases. The mean admission temperature rose from slightly hypothermic (36.41 °C) pre, to euthermic (36.53 °C) post intervention ( = 0.002). Patients achieved a temperature ≥36.5 °C in 86% of uses. In 1% of audits, patients were hyperthermic (37.6-37.9 °C). Both HCPs and parents reported a generally positive experience with the Warmer. HCPs were challenged to prepare it in advance of need. The Warmer functions similarly well in research and real-world conditions. Ongoing education directed toward both HCPs and parents is critical to ensuring the provision of a continuous heat chain. Engaging families in thermoregulation could ease the burden of overtaxed HCPs and improve the skill set of parents. Hypothermia is a preventable condition that must be addressed to optimize neonatal survival and outcome.
新生儿低体温是可预防的发病率和死亡率的主要原因，尤其是在世界上最贫困的新生儿中。当袋鼠式母亲护理 (KMC) 不足或无法提供时，需要使用产热包裹，但关于这种包裹的研究很少。Dream Warmer 是一种旨在补充 KMC 的包裹，已在正式研究环境中进行了广泛研究，但在实际条件下尚未进行研究。我们使用实施科学方法来了解 Dream Warmer（以下简称“Warmer”）的安全性、有效性和功能性；它对临床工作流程的影响；它与 KMC 等其他护理方面的相互作用；以及医疗保健提供者 (HCP) 和父母对 Warmer 的接受程度。我们在卢旺达农村的 6 家地区医院和 84 家相关保健中心进行了一项前瞻性、干预性、单臂、开放标签、混合方法研究。我们的干预措施是提供 Warmer 和关于体温调节的教育课程。我们使用病历、审计和调查比较了干预前后的数据。
Warmer 没有安全问题。在绝大多数情况下，它都被正确使用。入院时的平均体温从轻度低体温（36.41°C）升高到干预后（36.53°C）（ = 0.002）。在 86%的使用中，患者达到了≥36.5°C 的温度。在 1%的审计中，患者出现了高热（37.6-37.9°C）。HCP 和父母都报告说对 Warmer 的体验一般是积极的。HCP 面临着在需要之前准备好它的挑战。
Warmer 在研究和实际条件下同样有效。针对 HCP 和父母的持续教育对于确保提供连续的热链至关重要。让家庭参与体温调节可以减轻过度劳累的 HCP 的负担，并提高父母的技能水平。低体温是一种可预防的疾病，必须加以解决，以优化新生儿的生存和结局。
