Determining Consensus Alignment and Barriers of Neonatal Thermal Management in Nepal Using a Modified Delphi Process

Area of Science:

• Neonatology
• Public Health
• Pediatrics

Background:

• Neonatal hypothermia is a critical global health concern, with high incidence rates in both hospital and home births.
• This condition is particularly prevalent in Nepal, contributing to increased infant morbidity and mortality.
• Effective newborn thermal management is essential for reducing adverse outcomes.

Purpose of the Study:

• To identify and prioritize key practice standards for newborn thermal management in Nepal.
• To establish consensus on essential thermoregulation practices across different birth settings (hospital, health post, home).

Main Methods:

• A modified Delphi process was employed, involving 6 lead newborn physicians from major Kathmandu birthing centers.
• Practices were compiled from 14 World Health Organization recommended standards for newborn thermoregulation.
• Physicians ranked the top 5 key practice standards for various settings.

Main Results:

• Consensus was reached on most ranked thermoregulation practices.
• Disagreement was noted regarding the use of radiant heat sources in hospitals and Kangaroo Mother Care during homebirths.
• Interventions during the immediate delivery phase were identified as most impactful and feasible.

Conclusions:

• Nepali physicians prioritize thermoregulatory interventions during the immediate resuscitation period.
• There is a focus on practices that are both impactful and feasible in the Nepali context.
• Findings inform the development of targeted newborn thermal management guidelines in Nepal.