Neonatal Hypothermia at Birth: Clinical Determinants and Early Neonatal Outcomes in Low-Resource Settings

Abstract

Neonatal hypothermia at birth remains a significant but preventable contributor to early neonatal morbidity and mortality, particularly in low- and middle-income settings. This review synthesizes existing evidence on the prevalence of neonatal hypothermia at birth, its clinical determinants, and associated early neonatal morbidities and mortality. A narrative review of published observational studies, cohort analyses, and population-based reports was conducted, with neonatal hypothermia defined according to World Health Organization criteria. Maternal, intrapartum, environmental, and neonatal factors reported in the literature were examined, alongside documented short-term neonatal outcomes. Across diverse low-resource settings, neonatal hypothermia is consistently reported as common at birth, with higher prevalence among preterm and low birth weight infants and in contexts characterized by inadequate thermal care practices, prolonged labor, operative delivery, and suboptimal delivery-room environments. The reviewed evidence demonstrates strong associations between hypothermia at birth and adverse early neonatal outcomes, including respiratory distress, hypoglycemia, neonatal sepsis, increased need for intensive care, and early neonatal mortality. A dose–response relationship is frequently described, whereby moderate to severe hypothermia is associated with progressively higher mortality risk, even after accounting for gestational age and birth weight in adjusted analyses. These findings highlight neonatal hypothermia as an important marker of vulnerability and adverse early neonatal outcomes, rather than a benign transitional phenomenon. The literature consistently supports the effectiveness of simple, low-cost interventions—including immediate drying, skin-to-skin contact, early initiation of breastfeeding, and maintenance of warm delivery and transport environments—in reducing hypothermia-related morbidity and mortality. Strengthening adherence to evidence-based thermal care practices at birth should remain a priority in neonatal care strategies aimed at improving survival and reducing preventable neonatal deaths.