February 1, 2025Open Access

Admission Hypothermia and Neonatal Mortality in the Ethiopian Neonatal Network

Key Points

Admission hypothermia significantly increases the risk of neonatal mortality, especially in infants with lower body temperatures.
Among 12,363 newborns, over half were admitted with hypothermia, which is a major health concern in low-income countries.
Multivariable analysis revealed risk ratios up to 2.39 for infants admitted with temperatures below 33.9°C, indicating critical support needs.
Improving neonatal care, transport, and infrastructure can help reduce the incidence of hypothermia and related deaths.

Abstract

Background: Admission hypothermia remains a problem in low-income countries. Methods: This cross-sectional study evaluated the association between admission hypothermia (<36.5°C) and neonatal mortality for newborns discharged from neonatal units at 20 Ethiopian hospitals in 2021. Results: Among 12 363 newborns, 51.6% were admitted with hypothermia. Predictors for hypothermia and mortality included multiple birth, low birth weight, lower gestational age, and congenital anomalies. In a multivariable analysis, risk for mortality increased for infants admitted at <33.9°C aRR 2.39 (95% CI: 1.66, 3.45), 34.0°C to 34.9°C aRR 2.45 (95% CI: 1.88, 3.20), 35.0°C to 35.9°C aRR 2.00 (95% CI: 1.46, 2.74), and 36.0°C to 36.4°C aRR 1.59 (95% CI: 1.24, 2.04), compared to infants admitted at 36.5°C to 37.5°C. Conclusions: Admission hypothermia was associated with a twofold increased risk of death. To address hypothermia, basic essential newborn care, proper warm intra-facility transportation, improved infrastructure and equipment, and skin-to-skin care should be prioritized.

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