Neonatal Hypothermia and its Associated Factors among Neonates Admitted to the Neonatal Intensive Care Unit in Western Ethiopia: A cross-sectional study

The first few weeks of a newborn's life are a time of profound vulnerability. During this period, a baby's body is still learning how to regulate its own temperature, a task that requires energy and careful care. In many parts of the world, particularly in low-resource settings, this natural process is often disrupted by the environment. When a baby's body temperature drops too low, a condition known as hypothermia, it can trigger a dangerous chain reaction. The cold stresses the infant's system, making it harder to fight off infections, breathe properly, or maintain blood sugar levels. This is not merely a matter of feeling chilly; it is a critical medical emergency that contributes significantly to illness and death among newborns, especially in regions where access to advanced medical care is limited. Understanding why these temperature drops happen and identifying the specific moments where care can make a difference is essential for saving lives.

In the western part of Ethiopia, a team of researchers set out to investigate this exact problem within the Neonatal Intensive Care Units of public hospitals. They focused on the West Wallaga zone, a region encompassing several government hospitals that serve a population of over two million people. The team, led by nurses and health scientists from Salale University, conducted a detailed study over a three-month period in 2024. Their goal was simple yet vital: to determine how many newborns admitted to these intensive care units were suffering from hypothermia upon arrival and to uncover the specific factors that made some babies more likely to be cold than others. They examined the records and interviewed the mothers of 396 newborns, measuring each baby's temperature with a digital thermometer the moment they were admitted to the unit.

The results painted a stark picture. The researchers found that nearly three out of every five babies admitted to these intensive care units were already suffering from hypothermia. Specifically, 60.1 percent of the newborns had body temperatures below the normal range. The severity varied, with some babies experiencing mild drops in temperature, while others were in a moderate or even severe state of cold stress. This high prevalence suggests that the journey from birth to the hospital, or the moments immediately following delivery, often exposes these vulnerable infants to conditions that their bodies cannot withstand. The study did not just count the cases; it looked closely at the circumstances surrounding each birth to find the patterns behind the cold.

Several clear factors emerged as strong predictors of which babies were most likely to be cold. One of the most significant findings was the role of antenatal care. Mothers who had not visited a clinic for check-ups during their pregnancy were much more likely to have a baby admitted with hypothermia. These visits are crucial because they prepare mothers for birth and teach them about keeping their newborns warm. Another powerful factor was the timing of breastfeeding. Babies whose mothers did not start feeding them within the first hour of life were far more likely to be cold. Breastfeeding provides not just nutrition but also the energy a baby needs to generate its own body heat. The study also highlighted that babies born with complications during labor, those who were very young (less than 24 hours old), and those with a low birth weight were at the highest risk. Additionally, newborns who already had underlying health problems were significantly more likely to be hypothermic.

The researchers also looked at environmental and behavioral habits, such as whether the baby was kept skin-to-skin with the mother or if they were bathed immediately after birth. While some of these factors showed a connection in initial observations, the most consistent and powerful drivers of hypothermia remained the lack of prenatal care, the delay in starting breastfeeding, the presence of birth complications, and the baby's own age and weight. The study noted that the time of day a baby was born or whether they were born in a hospital versus a home did not show a statistically significant difference in the final analysis, suggesting that the quality of care and specific medical circumstances matter more than the setting itself.

This work provides a clear roadmap for improving care in these hospitals. The findings indicate that to reduce the number of cold babies, health workers must focus on ensuring mothers receive regular prenatal care and are educated on the importance of immediate skin-to-skin contact and early breastfeeding. Hospitals need to prioritize keeping newborns warm, especially in the first 24 hours of life and for those who are small or sick. By addressing these specific, manageable factors, the high rate of hypothermia can be reduced, offering a better chance of survival and health for the most vulnerable members of the community. The study serves as a reminder that while the challenges are significant, the solutions often lie in the fundamental practices of care and preparation.