Clinical detection of ‘cold stress’ is overlooked: an online survey of healthcare workers to explore the gap in neonatal thermal care in low-resource settings
Background Neonatal hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. The high prevalence of potentially preventable hypothermia today urges an investigation into why neonates still become hypothermic despite awareness o...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-10-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/6/1/e001606.full |
| _version_ | 1797774927919579136 |
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| author | Riccardo E Pfister Michiko Kyokan Veena Jirapaet Flavia Rosa-Mangeret Giorgia Brambilla Pisoni |
| author_facet | Riccardo E Pfister Michiko Kyokan Veena Jirapaet Flavia Rosa-Mangeret Giorgia Brambilla Pisoni |
| author_sort | Riccardo E Pfister |
| collection | DOAJ |
| description | Background Neonatal hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. The high prevalence of potentially preventable hypothermia today urges an investigation into why neonates still become hypothermic despite awareness of the problem and established thermal care guidelines. This study aimed to explore the gaps in knowledge and practices of neonatal thermal care among healthcare workers in low-resource settings.Methods A cross-sectional, questionnaire-based survey was performed online among healthcare workers in low-resource settings. We applied a purposive and snowballing sampling method to recruit participants through a two-round international online survey. Questionnaires were developed using themes of neonatal thermal care extracted from existing neonatal care guidelines.Results 55 neonatal care professionals participated in the first-round survey and 33 in the second. Almost all participants (n=44–54/55) acknowledged the importance of the WHO’s warm chain to keep a neonate warm. However, fewer participants (n=34–46/55) responded to practice them. When asked about cold stress, defined as a condition in which neonates are below optimum environmental temperature and using more oxygen and energy while maintaining normal body temperature, 15 out of 55 participants answered that checking extremity temperatures by hand touch was useless. Some participants reported concern about the extremity temperature’s inaccuracy compared with core temperature. Opinions and preferences for rewarming methods differed among participants, and so did the availability of warming equipment at their institutions.Conclusion An inadequate understanding of cold stress underestimates the potential benefits of extremity temperatures and leads to missed opportunities for the timely prevention of hypothermia. The current thermal care guidelines fail to highlight the importance of monitoring cold stress and intervening before hypothermia occurs. Therefore, we urge introducing the concept of cold stress in any neonatal thermal care guidelines. |
| first_indexed | 2024-03-12T22:28:19Z |
| format | Article |
| id | doaj.art-139232bece4c48aca856e451c541dfcf |
| institution | Directory Open Access Journal |
| issn | 2399-9772 |
| language | English |
| last_indexed | 2024-03-12T22:28:19Z |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj.art-139232bece4c48aca856e451c541dfcf2023-07-21T19:00:06ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722022-10-016110.1136/bmjpo-2022-001606Clinical detection of ‘cold stress’ is overlooked: an online survey of healthcare workers to explore the gap in neonatal thermal care in low-resource settingsRiccardo E Pfister0Michiko Kyokan1Veena Jirapaet2Flavia Rosa-Mangeret3Giorgia Brambilla Pisoni4Department of Neonatology, Geneva University Hospitals and Geneva University, Geneva, SwitzerlandInstitute of Global Health, University of Geneva, Geneva, SwitzerlandFaculty of Nursing, Chulalongkorn University, Bangkok, ThailandInstitute of Global Health, University of Geneva, Geneva, SwitzerlandEssentialTech Centre, Swiss Federal Institute of Technology in Lausanne, Lausanne, SwitzerlandBackground Neonatal hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. The high prevalence of potentially preventable hypothermia today urges an investigation into why neonates still become hypothermic despite awareness of the problem and established thermal care guidelines. This study aimed to explore the gaps in knowledge and practices of neonatal thermal care among healthcare workers in low-resource settings.Methods A cross-sectional, questionnaire-based survey was performed online among healthcare workers in low-resource settings. We applied a purposive and snowballing sampling method to recruit participants through a two-round international online survey. Questionnaires were developed using themes of neonatal thermal care extracted from existing neonatal care guidelines.Results 55 neonatal care professionals participated in the first-round survey and 33 in the second. Almost all participants (n=44–54/55) acknowledged the importance of the WHO’s warm chain to keep a neonate warm. However, fewer participants (n=34–46/55) responded to practice them. When asked about cold stress, defined as a condition in which neonates are below optimum environmental temperature and using more oxygen and energy while maintaining normal body temperature, 15 out of 55 participants answered that checking extremity temperatures by hand touch was useless. Some participants reported concern about the extremity temperature’s inaccuracy compared with core temperature. Opinions and preferences for rewarming methods differed among participants, and so did the availability of warming equipment at their institutions.Conclusion An inadequate understanding of cold stress underestimates the potential benefits of extremity temperatures and leads to missed opportunities for the timely prevention of hypothermia. The current thermal care guidelines fail to highlight the importance of monitoring cold stress and intervening before hypothermia occurs. Therefore, we urge introducing the concept of cold stress in any neonatal thermal care guidelines.https://bmjpaedsopen.bmj.com/content/6/1/e001606.full |
| spellingShingle | Riccardo E Pfister Michiko Kyokan Veena Jirapaet Flavia Rosa-Mangeret Giorgia Brambilla Pisoni Clinical detection of ‘cold stress’ is overlooked: an online survey of healthcare workers to explore the gap in neonatal thermal care in low-resource settings BMJ Paediatrics Open |
| title | Clinical detection of ‘cold stress’ is overlooked: an online survey of healthcare workers to explore the gap in neonatal thermal care in low-resource settings |
| title_full | Clinical detection of ‘cold stress’ is overlooked: an online survey of healthcare workers to explore the gap in neonatal thermal care in low-resource settings |
| title_fullStr | Clinical detection of ‘cold stress’ is overlooked: an online survey of healthcare workers to explore the gap in neonatal thermal care in low-resource settings |
| title_full_unstemmed | Clinical detection of ‘cold stress’ is overlooked: an online survey of healthcare workers to explore the gap in neonatal thermal care in low-resource settings |
| title_short | Clinical detection of ‘cold stress’ is overlooked: an online survey of healthcare workers to explore the gap in neonatal thermal care in low-resource settings |
| title_sort | clinical detection of cold stress is overlooked an online survey of healthcare workers to explore the gap in neonatal thermal care in low resource settings |
| url | https://bmjpaedsopen.bmj.com/content/6/1/e001606.full |
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