Differences in thermal adaptation of infants delivered at primary or tertiary care facilities in India

Abstract

To compare the pattern of thermal stabilization seen in infants born at a rural primary health center (PHC) with that of infants born in an modern urban tertiary care hospital (TCH). Abdominal temperature (Ta) and foot temperature (Tf) of healthy term newborn infants were monitored and electronically recorded continuously from birth in the delivery room (DR) until 12 h of life in the postnatal ward (PNW) at two sites. A total of 71 infants were enrolled in the study: 51 infants at the PHC and 20 infants at the TCH. In infants delivered at TCH the maximum mean (±s.d.) Ta of 36.4 ° C ± 0.48 was reached by 12 h, while at PHC maximum mean Ta was 35.4 °C (1.98) by 10.5 h. The mean Tf improved from the lowest value of 29.7 °C ± 1.3 at 4.5 h to 32.9 °C±1.6 by 12 h of life in infants delivered at TCH, whereas in infants delivered at PHC Tf remained low (maximum 30.7 °C) all through 12 h. The mean Td (Ta-Tf) gradually decreased from a maximum of 5.9 °C ± 1.6 at 4.5 h to 3.5 °C ± 1.5 by 12 h of life in infants born at TCH, but the Td remained at >5 °C even after 6 h of life in infants born at PHC, which was statistically significant (P<0.05). The calculated area between the Ta and Tf, a proxy for metabolic stress was greater in babies born at PHC than those born at TCH. Our study shows that although both groups of newborn infants experienced significant thermal stress, infants delivered at PHC experienced significantly greater thermal stress than babies born at TCH. This difference could be attributed to the differences in thermal environment of DR and PNW between PHC and TCH.