Thermal Protection of Newborns: The World Health Organization Guidelines Need to Include Clear and Feasible Options for Low-Resource Settings

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  •   Subhashchandra Daga

Abstract

Backgorund: Hypothermia in babies may increase mortality, directly or indirectly, by potentiating the effect of the other morbidities. Guidelines published by The World health organization (WHO) on newborn health (2015) may be inadequate to address the issue in a low-resource setting. To be relevant in such a context, they should be user-friendly for the trainers of health workers (HW) who may be responsible for interpreting the recommendations and training the HW.


Text: According to earlier guidelines (2013), ‘No randomized or quasi-randomized trial that evaluated the impact of keeping infants warm after discharge (hospital births) or after 24 hours (home births) was identified’. However, kangaroo mother care (KMC), a strong recommendation with moderate-quality evidence, and thermal protection are inseparable, as the most crucial component of KMC is skin-to-skin contact, which keeps a baby warm. A HW may be surprised when the guidelines or the basis change and, the move comes at a time when the earlier guidelines (1993) are just finding roots in patient care practices. Current guidelines are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, where randomized trials assume more importance. The guidelines recommend the following methods to keep infants warm after birth: KMC (strong recommendation, moderate-quality evidence), intermittent KMC (strong recommendation, moderate-quality evidence), and radiant warmers or incubators (strong recommendation, very low-quality evidence). The divergence between the evidence and the recommendations may be difficult for the HW to comprehend.


Conclusions: The guidelines for postnatal care need to be revisited and revised so that clear and feasible options for keeping infants warm in low-resource settings are offered. Besides KMC, warm rooms, heated mattresses, plastic wraps and Styrofoam boxes may be suggested.


What is already known about this subject?


•       In the absence of a randomized or quasi-randomized trial that evaluated the impact of keeping infants warm, there are fewer options in a low-resource setting.


•       They include Kangaroo mother care and incubators/radiant warmers.


What does this study add?


•       Options that may not have been supported by randomized trials but have consistent results may be suggested.


•       They include warm rooms, heated mattresses, plastic wraps and Styrofoam boxes.


•       In future revisions, the level of evidence should be paired with the recommendations.


How might this impact on clinical practice or future developments?


The health worker may choose the most feasible option at home or at a facility.


Keywords: GRADE methodology, hypothermia in a newborn, keeping babies warm, WHO guidelines on newborn care

References

World Health Organization. WHO recommendations on Newborn Health Guidelines approved by the WHO Guidelines approved by the WHO Guidelibes Review Commitee. [Internet] 2017 Available from: https://www.who.int/maternal child adolescent/documents/newborn-health-recommendations/en/.

Oxman AD, Lavis JN, Fretheim A. Use of evidence in WHO recommendations. Lancet. 2007; 369: 1883-1889.

Hill S, Pang T. Leading by example: A culture change at WHO. Lancet. 2007; 369: 1842-1844.

Lunze K, Bloom DE, Jamison DT, Hamer DH. The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival. BMC Med. 2013; 11(1): 1-25.

World Health Organization. Safe Motherhood. Thermal Control of the Newborn: A practical guide. [Internet] 1993. Available from: https://www.who.int/maternal_child_adolescent/documents/ws42097th/en/.

World Health Organization. WHO recommendations on postnatal care of the mother and newborn. [Internet] 2013. Available from: https://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/.

Chan GJ, Valsangkar B, Kajeepeta S, Boundy EO, Wall S. What is kangaroo mother care? Systematic review of the literature. Journal Global Health. 2016; (6)1.

Daga SR, Daga AS. Reduction in neonatal mortality with simple interventions. Journal of Tropical Pediatrics. 1989; 35: 197-189.

Daga SR, Sequera D, Goel S, Desai B, Gajendragadkar A. Adequacy of solar energy to keep babies warm. Indian Pediatrics. 1996; 33:102-104.

Daga S. Reinforcing kangaroo mother care uptake in resource-limited settings. Maternal Health Neonatal Perinatology. 2018; 4(1): 1-5.

Sarman I, Tunell R. Providing warmth for preterm babies by a heated, water filled mattress. Achieves of Disease in Childhood. 1989; 64: 29-33.

Green-Abate C, Tafari N, Rao MR, Yu KF, Clemens JD. Comparison of heated water-filled mattress and space-heated room with infant incubator in providing warmth to low-birth-weight newborns. International Journal of Epidemiology. 1994; 23: 1226-1233.

Boo NY, Selvarani S. Effectiveness of a simple heated waterfilled mattress for the prevention and treatment of neonatal hypothermia in the labourroom. Singapore Medical Journal. 2005; 46: 387-3891.

Gray PH, Paterson S, Finch G, Hayes M. Cot‐nursing using a heated, water‐filled mattress and incubator care: a randomized clinical trial. Acta Paediatrica. 2004; 93: 350-355.

Li S, Guo P, Zou Q, He F, Xu F, Tan L. Efficacy and safety of plastic wrap for prevention of hypothermia after birth and during NICU in preterm infants: a systematic review and meta-analysis. PLoS One. 2016; 11(6): e0156960.

World Health Organization. WHO recommendations on interventions to improve preterm birth outcomes. 2015.

Daga SR. Sole is the mirror of newborn's health. Journal of Tropical Pediatrics. 1992; 38(1): 41.

Hillier S, Grimmer-Somers K, Merlin T, Middleton P, Salisbury J, Tooher R, et al. FORM: An Australian method for formulating and grading recommendations in evidence-based clinical guidelines. BMC Medical Research Methodology. 2011; 11(1): 1-8.

Barbui C, Dua T, van Ommeren M, Yasamy MT, Fleischmann A, Clark N, et al. Challenges in developing evidence-based recommendations using the GRADE approach: the case of mental, neurological, and substance use disorders. PLoS Med. 2010; 8(2): e82131.

World Health Organization. Sustainable Development Goal 3: Health. 2000. [Internet] Available from:

https://www.who.int/topics/sustainable-development-goals/targets/en

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How to Cite
Daga, S. (2021). Thermal Protection of Newborns: The World Health Organization Guidelines Need to Include Clear and Feasible Options for Low-Resource Settings. European Journal of Clinical Medicine, 2(6), 13–16. https://doi.org/10.24018/clinicmed.2021.2.6.154