Neonatal hyperthermia and thermal stress in low- and middle-income countries: a hidden cause of death in extremely low-birthweight neonates.BACKGROUND
 A lifetime temperature plot with a clearly visible reference zone was developed, from which all thermal stresses and their duration associated with mortality were identified and defined on the basis of their characteristics.  Methods of quantifying the magnitude and duration of these thermal stresses were devised to enable definition of critical values.  This was then applied to calculate a measure of the various thermal stresses which may have contributed to neonatal death.


 Hypothermic events were very common in all the infants in the study period, but were not significantly associated with mortality.  However, hyperthermic events occurred in 35% of the infants and were more likely to be associated with mortality.  Most neonates with prolonged hypothermia culminating in rapid hyperthermia survived.  However, all ELBW neonates who experienced prolonged hyperthermia culminating in rapid hypothermia died within 8 hours of the event.  Hyperthermia is a high-risk event in ELBW infants and methods of cooling a high and prolonged temperature must be reviewed.
THERM