Background

Every year, across the world, 15 million babies are born too soon. Sadly, 1 million die before their fifth birthday - many in Africa. In Kenya, around 20 babies out of 1000 die in their first month of life - many because they were born early.

Babies who are born early (also known as premature or preterm) aren’t able to keep their temperature normal and many babies can get cold very easily. When a baby’s temperature drops below 36.5°C, this is known as hypothermia. When babies develop hypothermia, they are at risk of other complications and sadly sometimes this can lead to death.

Keeping babies warm after birth is essential. There are many ways in which babies can be kept warm, but sometimes on busy labour wards in hospitals in Kenya, babies’ temperatures can drop, and these babies need closer monitoring.

Simple tools are needed to help staff on the labour wards to keep babies' temperatures normal including what actions to take if their temperature drops. One such tool to help staff could be a simple monitoring chart where staff document a baby’s temperature and, depending on the temperature level, they then take appropriate action, according to information on the chart. All of the actions that staff would take to keep the baby warm have already been proven to be effective. In this study, we want to test whether putting everything together, including the chart, into what is known as a ‘care bundle’ can help.

What is the NEWS-HEAT Trial?

NEWS-HEAT stands for Neonatal Early Warning Score for Hypothermia Evaluation And Treatment. It is a research study that is being carried out in 28 hospitals across Kenya, in the labour wards, newborn units and postnatal wards.

First, to understand what happens now in the labour ward, we will ask staff to keep a record of babies’ temperatures and clinical information. After three months, we will then train all staff in the labour ward on something called Early Essential Newborn care, or EENC for short. During this time, we will keep asking the labour ward staff to keep a record of babies’ temperatures and other important outcomes. Then, in half of the hospitals we will ask them to start using the monitoring chart. In the other half of the hospitals, they will continue as normal. The hospitals can’t choose whether they will use the chart or not - this is decided at random. This is so we can make a fair comparison. In the hospitals who are using the chart, if a baby’s temperature is low, staff will check the chart to tell them what actions they should take. All of the actions have been proven to be effective at improving a baby’s temperature, and include things like wrapping the baby in plastic wrap so heat cannot escape or placing the baby under a overhead heater.

What are we trying to find out?

We want to know if using the NEWS-HEAT care bundle:

• Reduces the number of babies with hypothermia at the time of admission to the next point of care (for example newborn unit, postnatal ward)
• Improves outcomes for newborns in Kenyan hospitals

We'll compare babies’ temperatures at admission between hospitals using the NEWS-HEAT care bundle and those providing standard care.

Who can take part?

All babies who are born before 37 weeks and/or weighed less than 2.5kg at birth in the hospitals included will be cared for in accordance with the study, depending on what phase of the study the hospital is in.

What happens at the end of the study?

At the end of the study the results will be published in scientific medical journals and presented at conferences. We will also share the results on this website and send them to other organisations who are interested in improving outcomes for babies born too soon. No babies or families will be identified in any publications or media.