DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY

Neonatal early warning score for hypothermia evaluation and treatment (NEWS-HEAT): a cluster randomised controlled trial with internal pilot phase

Project disclaimer

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Description

Globally, 15 million babies are born prematurely every year. One million babies die before their 5th birthday, many due to complications of prematurity. In Kenya, the neonatal mortality rate (death in the first month of life) is 20 per 1000 live births. This is 8 times higher than the UK and much higher than the Sustainable Development Goals' target of less than 12 per 1000 live births by 2030. Babies born premature (before 37 weeks) or low birth weight (LBW; less than 2.5kg) often become cold (hypothermia) after birth as they cannot keep themselves warm. In Kenya, around half of babies who are admitted for neonatal care have hypothermia on admission. Cold babies are more likely to die or have other life-threatening conditions. Keeping babies warm in the labour ward and during transfer for further care is vital. In 2018, our multidisciplinary UK-Kenya collaboration started a research programme, to investigate if an early warning score could help identify preterm babies who are sicker, where action needs to be taken quickly. An early warning score (EWS) is a simple, paper document which uses a traffic-light colour-coded system to record babies' vital signs, like temperature, offering a simple way for health professionals to identify babies who need additional care. This prompts them to act, monitor how the baby responded and decide if further action is needed. We found that using EWS is possible and health professionals, parents and policy-makers support its use. Labour wards in Kenya are often under-resourced and staff are not fully trained in newborn care. Although early essential newborn care (EENC) is standard care it is not well implemented. Without a clear process of how to record temperature, put in measures to keep babies warm, and monitor their progress, babies often get cold. NEWS-HEAT is a care bundle, which includes evidence-based actions to keep babies warm and prevent hypothermia. It is a paper chart with an EWS and decision-aid to trigger action and monitor babies. NEWS-HEAT could help staff and parents note when babies are cold, act to warm them, and continue to monitor to ensure babies stay warm. We will test if NEWS-HEAT will reduce the number of babies who are cold. We will randomly allocate 28 hospitals to use EENC, with or without the NEWS-HEAT bundle. Each hospital will take part for 8 months. In all hospitals, before any intervention takes place, we will collect baseline data on all preterm/LBW babies. Then, all hospitals will receive training in EENC, using a train-the-trainer approach. Finally, staff in half of hospitals will receive training on and then implement the NEWS-HEAT care bundle. The other half of hospitals will continue to use EENC alone. We will measure which group of hospitals has fewer babies who became cold by recording the temperatures at the point of admission for newborn care. We will also check other important outcomes including how many babies die within 1 week of birth. We anticipate 11,200 babies being involved. We will also conduct a process evaluation to check if NEWS-HEAT is implemented properly and staff views of it. Our partners include the Ministry of Health and a parent support group. NEWS-HEAT has the potential to reduce hypothermia and save babies' lives in Kenya and other low and middle income countries, contributing to reaching the Sustainable Development Goals.

Objectives

ISPF aims to foster prosperity by solving shared global research and innovation challenges. This will be done through working closely with international partners to: support research excellence and build the knowledge and technology of tomorrow strengthen ties with international partners that share our values; enable researchers and innovators to cultivate connections, follow their curiosity and pioneer transformations internationally, for the good of the planet. Activities under ISPF ODA aim to deliver research and innovation partnerships with low- and middle-income countries.

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Location

The country, countries or regions that benefit from this Programme.

Kenya

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