Gaps in neonatal thermal care in low-resource settings: A web-based survey of healthcare workers.

Abstract Background: Hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. Despite the recognition of the importance of thermal care for neonates a century ago and the established WHO guidelines, a high prevalence of neonatal hypothermia is still regularly reported. Hypothermia is avoidable in the majority of neonates because it is not a complication of prematurity but more the result of inadequate thermal care. The objective of this study was to explore the current gaps in knowledge and practice in neonatal thermal care among healthcare workers in low-resource settings.Methods: We conducted a 2-round, web-based survey of a purposive and snowball sample of healthcare workers in neonatal care in low-resource settings. The questionnaire was developed using themes of neonatal thermal care extracted from existing neonatal care guidelines, including WHO’s. The survey asked multiple-choice questions, supplemented by open-ended questions to capture first hand insights and information on neonatal thermal care. Results of the survey were analysed using Microsoft Excel. Data was collated and summarized using descriptive measures. Results: Almost all participants acknowledged the importance of all the WHO warm chain elements, however, fewer participants responded positively regarding the practice of this warm chain. Only 56% of the participants acknowledged the usefulness of checking the hand or foot temperature by hand-touch. The usefulness of the axillary or rectal temperature was valued higher than that of the hand or foot temperature as an indicator of cold stress. Opinions diverged regarding the hand or foot temperature, including apparent inaccuracy compared to axillary or rectal temperature. Preferences on rewarming strategies widely differed among participants and so did the availability of warming equipment in their institutions. Conclusions: We identified the general acknowledgment of the importance of the WHO warm chain but also its limited practice. We also identified that an inadequate understanding of cold stress underestimates the potential benefits of the hand or foot temperature and leads to missed opportunities for timely prevention of hypothermia. Furthermore, lack of consistent guidance on equipment for rewarming hypothermic neonates hampers recovery.