Thermal status and clinical condition of referred neonates at arrival in a tertiary care referral nursery in Pakistan.

Abstract

Objective: To determine the thermal status and associated clinical conditions of referred neonates at arrival in a tertiary care referral nursery in Pakistan, and to assess their associations with short-term outcomes. Study Design: Observational Cohort study. Setting: Department of Neonatology, Children’s Hospital & Institute of Child Health, Faisalabad. Period: 1^st January to 30^th June 2025. Methods: A total of 355 consecutively referred neonates ≤28 days were enrolled. Axillary temperature was measured within 15 minutes of arrival. Other variables included gestational age, birth weight, mode of delivery, clinical colour, feeding ability, blood glucose, referral reason, oxygen support, and need for IV resuscitation. Outcomes at 48 hours were categorized as alive, expired, or left against medical advice (LAMA). Statistical analysis was performed using SPSS v26. Descriptive summaries and chi-square tests assessed associations (p<0.05 considered significant). Results: Of 355 neonates, 148 (41.7%) were preterm. Hypothermia was present in 112 (31.5%) including mild (28.5%) and severe (3.1%). Hypothermia was significantly associated with mortality (p=0.000). Hypoglycemia occurred in 41 (11.5%) neonates and was also linked to mortality (p=0.029). Oxygen delivery method and IV bolus administration were both associated with poor outcomes (p=0.000). At 48 hours, 275 (77.5%) survived, 65 (18.3%) expired, and 15 (4.2%) left against medical advice.
Conclusion: Hypothermia, hypoglycemia, invasive ventilation, and IV bolus administration were significantly associated with mortality among referred neonates. Findings emphasize strengthening of referral stabilization practices—thermal protection, glucose monitoring, safe oxygen delivery, and rational fluid therapy.