Discussion
death, hypothermia
EVENTS, NEWBORN MORBIDITY, COMPLICATIONS, NEONATAL HYPOTHERMIA
The current RCT was conducted in LBW newborns to study the impact of BEMPU (a hypothermia-detecting bracelet) on KMC hours at home. The newborns in the BEMPU group received KMC for a longer duration as compared to the control group for four weeks after discharge.Despite thermal care being considered as an essential component of the care of newborns, the incidence of neonatal hypothermia is quite high because simple, low cost and acceptable tools to monitor temperature continuously are scarceMaintenance of normothermia in preterm and low birth weight neonates is vital for neonatal survival. However, even when all precautions are taken, there were still incidents of drop in temperature below 36.5 °C that would have been undetected for hours or longer without the BEMPU bracelet device, as shown by the current study.In the current study, despite advice about KMC and education about hypothermia, drop in temperature episodes were detected by the BEMPU device. Thus, this study reveals only the tip of the iceberg of undiagnosed low body temperature in neonates. In a non-research clinical setting, it is likely that there might be more episodes of neonatal hypothermia. Data from the current study thus demonstrate the need for the BEMPU bracelet in detecting temperature drops below 36.5 °C. Early diagnosis of hypothermia would help parents intervene earlier and prevent moderate and severe hypothermia complications.The BEMPU previously underwent validation study at Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India. The BEMPU had sensitivity of 98.57, specificity of 99.62, a positive predictive value of 83.45%, and a negative predictive value of 99.62%Furthermore, in a nonrandomized field trial in Rajasthan (India), the BEMPU group had lower mortality (6%) than the non-BEMPU group (14%). Due to poor follow-up and tracking of KMC hours, this study could not report the influence of BEMPU on the number of KMC hours and weight changes between the groups. However, the authors believe that a higher follow-up rate in the BEMPU group (59.58%) vis-à-vis the Control group (31.34%) indicated that BEMPU would have promoted a positive behavior change in the parents on newborn careThe study from Rajasthan was from tribal belts, and hence underprivileged population was studied. Our institution is the only tertiary care center for neonates in our region, and most of the population that we serve is underserved with poor socioeconomic status. The loss to follow-up was observed in the current study, both from BEMPU and Control groups. It was mainly attributed to longer distances, financial constraints, and social reasons involved in attending weekly follow-up appointments.Unlike the current study and the study from Rajasthan, similar RCT from Australia was terminated early as interim analysis showed that there were very few hypothermia events occurring in both groups. This limits the possibility of the BEMPU device being of any additional benefit in resource-rich settings where hypothermia events are rareIn addition to hypothermia prevention, KMC also increases exclusive breastfeeding, weight, length, and head circumferenceThere are certain limitations of the study. Significant proportion of newborns were dropouts in the study. Home visits by the authors were not done to assess the socio-demographic and environmental factors. Verbal autopsy of causes of death was not done.The findings of this single-center study suggest that in controlled environments like hospital settings where periodic temperature monitoring is done in addition to clinical examination, the utility of such devices need to be further studied at varied setups. Further research studies are also required to understand the perception and extent of the problem and the feasibility and effectiveness of temperature measurement devices for preventing newborn morbidity and mortality at the community level. The authors strongly suggest replication of the study in different regions of India and across the globe to assess the effectiveness of BEMPU in improving KMC hours along with feasibility and economic analysis before implementing the same.