Ellis M, Manandhar N, Shakya U, Manandhar D S, Fawdry A, Costello A M
Centre for International Child Health, Institute of Child Health, London.
Arch Dis Child Fetal Neonatal Ed. 1996 Jul;75(1):F42-5. doi: 10.1136/fn.75.1.f42.
To describe the pattern of hypothermia and cold stress after delivery among a normal neonatal population in Nepal; to provide practical advice for improving thermal care in a resource limited maternity hospital.
The principal government funded maternity hospital in Kathmandu, Nepal, with an annual delivery rate of 15,000 (constituting 40% of all Kathmandu Valley deliveries), severe resource limitations (annual budget Pounds 250,000), and a cold winter climate provided the setting. Thirty five healthy term neonates not requiring special care were enrolled for study within 90 minutes of birth. Continuous ambulatory temperature monitoring, using microthermistor skin probes for forehead and axilla, a flexible rectal probe, and a black ball probe placed next to the infant for ambient temperature, was carried out. All probes were connected to a compact battery powered Squirrel Memory Logger, giving a temperature reading to 0.2 degree C at five minute intervals for 24 hours. Severity and duration of hypothermia, using cutoff values of core temperature less than 36 degrees C, 34 degrees C, and 32 degrees C; and cold stress, using cutoff values of skin-core (forehead-axilla) temperature difference greater than 3 degrees C and 4 degrees C were the main outcome measures.
Twenty four hour mean ambient temperatures were generally lower than the WHO recommended level of 25 degrees C (median 22.3 degrees C, range 15.1-27.5 degrees C). Postnatal hypothermia was prolonged, with axillary core temperatures only reaching 36 degrees C after a mean of 6.4 hours (range 0-21.1; SD 4.6). There was persistent and increasing cold stress over the first 24 hours with the core-skin (axillary-forehead) temperature gap exceeding 3 degrees C for more than half of the first 24 hours.
Continuous ambulatory recording identifies weak links in the "warm chain" for neonates. The severity and duration of thermal problems was greater than expected even in a hospital setting where some of the WHO recommendations had already been implemented.
描述尼泊尔正常新生儿群体出生后体温过低和冷应激的模式；为资源有限的妇产医院改善体温护理提供实用建议。
研究地点为尼泊尔加德满都主要由政府资助的妇产医院，年分娩率为15000例（占加德满都谷地所有分娩的40%），资源严重受限（年度预算250,000英镑），且冬季气候寒冷。35名不需要特殊护理的健康足月儿在出生后90分钟内被纳入研究。使用微型热敏电阻皮肤探头分别测量额头和腋窝温度、柔性直肠探头以及置于婴儿旁边的黑球探头测量环境温度，进行连续动态体温监测。所有探头均连接到一个紧凑的电池供电的松鼠记忆记录器，每5分钟记录一次温度读数，持续24小时，温度读数精确到0.2摄氏度。主要观察指标为体温过低的严重程度和持续时间（采用核心温度低于36摄氏度、34摄氏度和32摄氏度的临界值）；以及冷应激（采用皮肤 - 核心（额头 - 腋窝）温差大于3摄氏度和4摄氏度的临界值）。
24小时平均环境温度普遍低于世界卫生组织建议的25摄氏度水平（中位数22.3摄氏度，范围15.1 - 27.5摄氏度）。产后体温过低持续时间较长，腋窝核心温度平均在6.4小时后才达到36摄氏度（范围0 - 21.1；标准差4.6）。在出生后的头24小时内，冷应激持续存在且不断增加，核心 - 皮肤（腋窝 - 额头）温差在头24小时的一半以上时间超过3摄氏度。
连续动态记录可识别新生儿“保暖链”中的薄弱环节。即使在已经实施了部分世界卫生组织建议的医院环境中，体温问题的严重程度和持续时间仍比预期的要大。
