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SPREADING THE WARMTH to SAVE LIVES

Overview of Hypothermia31/03/2016

IN PARTNERSHIP WITH:

GRACE HSIA, CEO hsgracie@warmilu.com+1 (248) 835-8703www.warmilu.com

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Source: WHO Premature Birth, Fact Sheet N°363, November 2015http://www.who.int/mediacentre/factsheets/fs363/en/

15 million premature infants are born annually. 1.5 million die in resource scarce settings.

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Hypothermia in Premature Infants

WHO defines hypothermia in levels as the following temperature values in infants: Cold stress or mild hypothermia: 36.0 C to 36.4 C (96.8 F - 97.5 F)Moderate hypothermia: 32.0 C to 35.9 C (89.6 F to 96.6 F)Severe hypothermia: <32 C (89.6 F)

Other Symptoms: A weak cry; Low energy level; Lethargic; Reddish and cold skin; Cool feeling of extremities and abdomen; Poor feedingHypoglycemia (low blood sugar); Hypoxia (low levels of blood oxygen) or apneic (absense of breathing) episodes; Heart arrhythmias. Chronic Hypothermia: Weight loss, no weight gains, or failure to thrive.

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Of 1.5 million deaths, 75% could be saved with co-interventions including thermal care, safe

oxygen use, and CPAP.

For 1°C in temperature, there is a 28% in infant mortality.

Sources: Pediatrics. 2007 Mar;119(3):e643-9. Epub 2007 Feb 12. Admission temperature of low birth weight infants: predictors and associated morbidities. Laptook AR1, Salhab W, Bhaskar B; Neonatal Research Network.

Preterm births in 2010. Source: Blencowe, H., et al. (2012) Chapter 2: 15 million preterm births: Priorities for action based on national, regional and global estimates. In Born Too Soon: the Global Action Report on Preterm Birth.http://www.who.int/pmnch/media/news/2012/borntoosoon_chapter2.pdf 2012 [79]. Not applicable = non WHO Members State. Review Maternal inflammation, growth retardation, and preterm birth: insights into adult cardiovascular disease. Rogers LK, Velten M Life Sci. 2011 Sep 26; 89(13-14):417-21.

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More than 60% of preterm births occur in Africa and South Asia, but preterm birth is a global problem.

Source: WHO Premature Birth, Fact Sheet N°363, November 2015http://www.who.int/mediacentre/factsheets/fs363/en/

Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, Adler A, Garcia CV, Rohde S, Say L, Lawn JE. National, regional and worldwide estimates of preterm birth. The Lancet, June 2012. 9;379(9832):2162-72. Estimates from 2010.

Wariki WMV and Mori R. Interventions to prevent hypothermia at birth in preterm and/or low-birth-weight infants: RHL commentary (last revised: 1 June 2010). The WHO Reproductive Health Library; Geneva: World Health Organization. <http://apps.who.int/rhl/newborn/cd004210_Warikiwmv_com/en/> UNICEF. Progress for children: a world fit for children statistical review. New York, NY: United Nations Children`s Fund; 2007. < http://www.unicef.org/publications/index_42117.html>

“Prevention and management of hypothermia is one of the key interventions for reducing neonatal mortality and morbidity in preterm infants.” According to UNICEF, interventions such as the Warmilu infant warming blanket can help reduce neonatal mortality or morbidity by 18-42%.

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156,700 -187,500 are born preterm and low birth weight. Of these

preterm infants 14,000 die and the leading cause is hypothermia or

pneumonia exacerbated by hypothermia. WHO says that 1 out of 3 newborn deaths in Kenya are a result of complications caused by

premature birth. Number of annual live births in Kenya. World Health Organization. May 2, 2012. Accessed October 27, 2015. http://www.who.int/pmnch/media/news/2012/201204_borntoosoon_countryranking.pdf

Calculated by evaluating the November 5, 2015 World Bank figures for the total 2013 Kenya population (44.35 million) and WHO % of preterm births

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Source: Florencedzame, https://florencedzame.wordpress.com/2013/06/28/shortage-of-incubators-in-public-hospitals-in-kenya/

• Electricity Scarce• Not Enough Incubators

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• Electricity Scarce

• No Incubators

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Intermittent Kangaroo Mother Care (KMC)• No Electricity• No Incubator

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Intermittent Kangaroo Mother Care (KMC)• No Electricity• No Incubator

Assist Moms with Intermittent Kangaroo Mother Care (KMC)• Goal = Capacity Building• Have Incubators &

Electricity

1st Case: Interventions in Rural India

• Study done in Uttar Pradesh (Northeast India)• Focused on unequal distribution of resources to

the poor• Inequity: Unequal distribution of a health

indicator or service exists among different social and economic groups, that these differences are unwanted and that known effective interventions are less available to the disadvantaged groups.

Some Statistics

• The poorest 20% of the population experiences twice as much mortality as the richest 20%.

• Neonatal Mortality accounts for 40% of under five child mortality rate.

What They Did

• Provide intervention packages.• Used CARE-India (NGO) to provide workers

and infrastructure to improve healthcare delivery performance.

• Aimed to increase equity and coverage through home visitation.

2nd Case: Interventions in Sub Saharan Africa Countries and South East Asia

• Was more elaborate and provided antenatal, intrapartum, and postnatal interventions

• Cost Effectiveness: Average cost effectiveness ratio and effectiveness based on impact on incidence, remission, and case fatality of the maternal and neonatal condition.

Some Statistics

• More than 4 million babies die in the first 28 days of life (38% mortality of aged 5 and below)

Key Takeaways

• Community care programs were highly effective.

• Care packages often cost less than their individual interventions combined.

• Kangaroo Mother Care

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SPREADING THE WARMTH to SAVE LIVESOverview of Hypothermia

Q&A31/03/2016

IN PARTNERSHIP WITH:

GRACE HSIA, CEO

www.warmilu.comhsgracie@warmilu.com | +1 (248) 835-8703

Postnatal Interventions Description

D5: Support for Breast Feeding + Support for low birthweight babies + Tetanus Toxoid

Cost Effectiveness: 7

Home visits to promote early and exclusive breast feeding by skilled workers. For low birth infants, visits to promote extra warmth for low birthweight babies.

Community Care for Newborn + Tetanus Toxoid

Cost Effectiveness: 7

Tetanus immunizations and care by a skilled worker

D9 : Community Based management of neonatal pneumonia (Included screening for preclamsia and D5)

Cost Effectiveness: 17

Home visits for diagnosis and management of pneumonia and treatment with antibiotics

Immediate Care:

D12 : Management of very low birthweight babies

Cost Effectiveness: 32

Inpatient care for very low birthweight babies, including special feeding support, additional warmth, close monitoring and treatment with oxygen if necessary

D12: Management of severe neonatal infections

Antibiotics

D12: Neonatal Asphyxia Treatment with oxygen

D12: Neonatal Jaundice Phototherapy

Adam T et al. BMJ 2005;331:1107

©2005 by British Medical Journal Publishing Group

Expansion path of most cost effective mix of interventions in Sear-D (countries in South East Asia with high adult and high child mortality) in 2000.

“DALY” extends the concept of potential years of life lost due to premature death