Frade Garcia Alejandro, Servitje Azcarraga Lucila, Espinosa Olivas María Azucena, García Ulloa Laila Zulema, Garcia Santisteban Rodrigo, Hansen Anne
Boston Children's Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
J Glob Health. 2025 Jun 2;15:04180. doi: 10.7189/jogh.15.04180.
Neonatal hypothermia is preventable but common, contributing to neonatal morbidity and mortality especially in low resource settings. Kangaroo Mother Care (KMC) is the preferred method to prevent hypothermia, but relying on it as a continuous heat source is challenging. This study introduced a novel Infant Warmer to complement KMC in a low resource community hospital through an implementation science approach.
We conducted a prospective, interventional cohort study in Jaltenango Chiapas, Mexico from January 2022 to November 2022. Our intervention was 1) an educational programme about the importance of euthermia and optimal thermoregulatory practices including KMC, and 2) provision of an Infant Warmer designed for low-resource settings with training of health care providers. Our hypothesis was that neonatal hypothermia rates would decrease after our intervention. Our aims were to reduce rates of hypothermia and increase knowledge and confidence regarding neonatal thermoregulation. The study had three phases: Pre-Intervention (January to May), Intervention, and Warmer Use (June to November). We collected clinical data during the Pre-Intervention and Warmer Use Phases, including temperature on admission and six hours later called 'Follow-Up'. At three-time points we conducted surveys of health care providers regarding their knowledge of hypothermia, confidence in keeping babies warm, and attitudes regarding the Warmer. We also conducted a parent survey.
We studied 372 newborns. Comparing Pre-Intervention to Warmer Use Phases, rates of hypothermia decreased from 62 to 27% on admission and 59 to 11% on Follow-Up. The mean admission and Follow-Up temperatures increased by 0.06°C (C) and 0.23°C (P = 0.003) respectively. Healthcare providers' knowledge of hypothermia and confidence in keeping newborns warm also improved throughout the study.
We found high baseline rates of neonatal hypothermia in this low resourced hospital. We successfully lowered hypothermia rates by providing appropriate equipment to complement KMC and improved knowledge of hypothermia through education interventions.
新生儿低体温是可预防的，但很常见，会导致新生儿发病和死亡，在资源匮乏地区尤其如此。袋鼠式护理（KMC）是预防低体温的首选方法，但将其作为持续热源具有挑战性。本研究通过实施科学方法，引入了一种新型婴儿暖箱，以在资源匮乏的社区医院辅助袋鼠式护理。
2022年1月至2022年11月，我们在墨西哥恰帕斯州哈尔特南戈进行了一项前瞻性干预队列研究。我们的干预措施包括：1）开展一项关于正常体温的重要性以及包括袋鼠式护理在内的最佳体温调节措施的教育项目；2）提供一款为资源匮乏地区设计的婴儿暖箱，并对医护人员进行培训。我们假设干预后新生儿低体温率会降低。我们的目标是降低低体温率，并提高有关新生儿体温调节的知识和信心。该研究分为三个阶段：干预前（1月至5月）、干预阶段和暖箱使用阶段（6月至11月）。我们在干预前阶段和暖箱使用阶段收集临床数据，包括入院时的体温以及六小时后的体温（称为“随访体温”）。在三个时间点，我们对医护人员进行了调查，了解他们对低体温的知识、保暖婴儿的信心以及对暖箱的态度。我们还进行了家长调查。
我们研究了372名新生儿。比较干预前阶段和暖箱使用阶段，入院时低体温率从62%降至27%，随访时从59%降至11%。入院时和随访时平均体温分别升高了0.06°C和0.23°C（P = 0.003）。在整个研究过程中，医护人员对低体温的知识以及保暖新生儿的信心也有所提高。
我们发现这家资源匮乏的医院新生儿低体温基线率很高。我们通过提供适当设备辅助袋鼠式护理成功降低了低体温率，并通过教育干预提高了对低体温症的认识。
