Easy way for hospitals to reduce heat-related sickness in newborns

Heat-related illnesses among newborns can be reduced significantly by adopting some very simple measures, which includes shifting of maternity ward from higher floors to lower floors in hospitals. This is crucial in a country like India where only 129 hospitals out of a total of about 16,000 have air-conditioning, says a study to be published in Journal of Environmental and Public Health. The study uses data and experience from SCL General Hospital in Ahmedabad which changed the floor of its maternity ward in the aftermath of heat wave of May, 2010.

What is a heat wave?   Heat wave onset is considered only after maximum temperature of a station reaches at least 40°C in the plains and at least 30°C in hilly regions When normal maximum temperature of a station is less than or equal to 40°C Heat Wave Departure from normal is 5°C to 6°C Severe Heat Wave Departure from normal is 7°C or more When normal maximum temperature of a station is more than 40°C Heat Wave Departure from normal is 4°C to 5°C Severe Heat Wave Departure from normal is 6°C or more When actual maximum temperature remains 45°C or more, irrespective of normal maximum temperature, heat wave should be declared. Source: India Meteorological Department

The authors of the study collected data on the number of admissions to neonatal intensive care unit (NICU) of the hospital run by Ahmedabad Municipal Corporation from April 1-June 30, hottest months of the year. They found that there were eight heat-related admissions of neonates (0-28 day-old infants) in 2009 and four in 2011, as compared to 24 in 2010.

Heat-related illness among neonates was defined as babies with body temperature ≥38 Ôü░ C along with any of these signs or symptoms—refusal to feed, signs of dehydration, weight loss of more than 10 per cent of birth weight, increased respiratory rate, convulsions, and/or lethargy.

"The heatwave of May 2010 triggered the study. We excluded neonates who had heat-related symptoms, but could possibly have other illnesses like septicemia, acute gastroenteritis, or central nervous system infection. Thus, heat was left to be the only reason which could have led to the admission of the child," said Khyati Kakkad, lead author of the study and paediatrician at the hospital.

The average maximum temperature for the three summer months in 2009 was 40.8°C. For 2010, it was 41.8°C and for 2011 the average maximum temperature was 40.3°C. According to India Meteorological department, the days of April 17 and 18 and May 13 to 15, 17, and 20 to 25 in 2010, qualified as a heat wave with daily maximum temperatures varying between 44.5°– 46.8°C.

"After seeing so many heat-related cases in 2010 among children, which is a vulnerable population to heat changes, we shifted our maternity ward to the ground floor in 2011. Earlier it was on the top floor where the roof has tar coating to avoid water seeping in during monsoons. but it made the ward very hot," said Kakkad. The hospital is not air-conditioned.

Heat-related morbidity came down substantially in 2011 compared to 2010. But the authors noted that it was much lower than in 2009, a year without heat wave.

"The study showed that maintaining low temperature in general is good for health of neonates. Such small and simple changes in India with very few air-conditioned hospitals can be very helpful,” said Kakkad.

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