Comparison of heated water-filled mattress and space-heated room with infant incubator in providing warmth to low birthweight newborns.
BACKGROUND
Prevention of excessive heat loss is fundamental to survival of low birthweight (LBW) newborns. The use of infant incubators (INC) is beyond the resources of developing countries, and the space-heated room (SHR) has been the only feasible means of providing thermal protection to LBW newborns. Recently a thermostatically controlled, heated, water-filled mattress (HWM) has been developed as a potentially simpler and affordable alternative.


METHODS
In a neonatal care ward of a referral hospital in Addis Ababa, 62 < 1 week old newborns, weighing 1000-1999 g, who were well enough to breathe comfortably in room air and tolerate oral feeds, were randomly allocated to INC, HWM or SHR and followed for 3 weeks. The level of cold stress as assessed by core-to-skin temperature gradient and the rate of weight gain were the main outcome measures.


RESULTS
The level of cold stress was lowest in the INC, intermediate in the HWM and highest in the SHR. Relative to the INC group, the HWM group exhibited a modest increase in the occurrence of clinically important hyperthermic or hypothermic deviations in core temperature (rate ratio (RR) = 2.3; 95% CI: 0.9, 5.6), and the SHR displayed a definite increase (RR = 4.0; 95% CI: 1.7, 9.3). During the first week, the rate of weight gain was highest in the INC group (3.6 g/kg/day), lowest in the SHR group (-2.3 g/kg/day, P < 0.05 versus INC) and intermediate in the HWM group (1.6 g/kg/day, P > 0.1 versus INC).


CONCLUSIONS
Care in the SHR produced clinically significant thermal stresses and was associated with deficient early neonatal growth, but the use of HWM may constitute a feasible and clinically acceptable alternative in providing warmth to LBW newborns during the neonatal period.
Green-Abate
C
C
Department of Paediatrics and Child Health, Faculty of Medicine, Addis Ababa University, Ethiopia.
Tafari
N
N
Rao
M R
MR
Yu
K
K
Clemens
J D
JD
D001513:Beds; D001831:Body Temperature; D005002:Ethiopia; D006361:Heating / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D007186:Incubators, Infant; D007224:Infant Care / Q000379:methods*; D007230:Infant, Low Birth Weight / Q000502:physiology*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology; D007363:Intensive Care Units, Neonatal; D012017:Referral and Consultation