PREVENTABILITY OF NEONATAL COLD INJURY AND ITS CONTRIBUTION TO NEONATAL-MORTALITY

When the body temperature of a small neonate falls below 35-degrees-C, lassitude can be noted; severe derangements of cardiovascular, renal, hepatic, immunological, and hematological systems may also occur depending in part on the duration and severity of hypothermia. Diagnosis requires a low-reading thermometer, lacking which the diagnosis can be suspected, but most often is missed. Fatal cases of diagnosed cold injury commonly have terminal pneumonia or sepsis. Prevention involves identification and home visits to high-risk infants; intensive care of those with the diagnosis at Soroka Hospital Medical Center has reduced the case-fatality rate from 30% in 1971 to 3% in 1988-1989. During the same period in our region, the proportion of neonatal deaths occurring in winter months of December, January, and February has dropped from 55 to 27%. The expected proportion is 25%. We hypothesize that excess neonatal mortality during winter months, especially due to pneumonia and sepsis or sudden infant death syndrome (SIDS) is an indicator of missed cold injury syndrome. A preliminary evaluation was made from U.S. data by state, provided by the National Center for Health Statistics, which records no fatalities from cold injury during 1986. Contrasted with this are 26 cold injury deaths in Israel for 1977-1980. In the U.S., though, excess winter neonatal deaths in 1986 from SIDS, pneumonia, and sepsis are reported. These deaths amount to 13 out of 368 deaths attributed to SIDS and 8 out of 158 deaths from influenza and pneumonia and 7 out of 770 deaths from sepsis; however, from the states of North Carolina, South Carolina, Mississippi, Virginia, and Pennsylvania, the excess is about 21 deaths compared to the yearly number in these states of 219 from these causes. These states also have substantial portions of the population with poor education and substandard housing. The use of low-reading thermometers in a randomized clinical trial in such states would be justified. These findings are consistent with a possible reduction of about 10% in selected causes of neonatal mortality from an active program of detection of neonatal cold injury under high-risk conditions.