A core body temperature of less than 36.5 °C or a skin temperature of less than 36 °C is considered neonatal hypothermia, according to the World Health Organisation (WHO). ¹ A baby is said to have moderate hypothermia if their temperature is between 32.0 and 34.9°C (89.6 and 96.6°F), and severe hypothermia if it is lower. ² Hypothermia is a significant contributor to newborn fatalities globally, even though it seldom ends in death. This is mainly due to its co-morbidity with severe neonatal infections, premature birth, and asphyxia. ³ Hypothermia engenders a vicious cycle with physiological abnormalities such as hypoxia, hypoglycemia and shock. ⁴

Every year, an estimated four million newborns die. ⁵ Over 99 percent of newborn fatalities take place in underdeveloped nations. One million babies perish in the first month of birth each year, with India alone bearing one-fourth of the burden. ⁶ The case fatality rates (CFR) for newborn hypothermia vary from 8.5% to 52% globally. ³ According to a study by Wake et al, neonates with hypothermia had nearly five times the risk of dying as newborns than those with a normal body temperature. ⁶ This study will help achieve the Sustainable Development Goal of the UN, which is to guarantee healthy lives and promote well-being for everyone at all ages. ⁷

Teaching moms how to recognise the symptoms of newborn hypothermia and how to prevent it can be a crucial preventive measure. Only during their hospital stay do newborns have medical supervision. Therefore, it is essential to educate mothers who constantly keep a watch on and tend to the newborn. Researching the effects of maternal education will help reduce newborn hypothermia in general.

Anurag Srivastava et al. carried out a cross-sectional study among new mothers in Western Uttar Pradesh to ascertain the knowledge and practice gaps on newborn thermal care. It was shown that 60.9% of those surveyed knew exactly how to keep a newborn warm after delivery. ⁸

Mahvish Qazi et al. did a study in Northern India on mothers’ awareness of how to prevent neonatal hypothermia. It was shown that while 45% of moms knew how to rapidly wipe a newborn to keep them warm, just 3% of mothers were familiar with kangaroo mother care. ⁹

In Jimma, South West Ethiopia, a research by Kebede et al. indicated that 32.5% of moms practiced early newborn bathing. Since it causes newborn hypothermia and related problems, this needs to be addressed first. ¹⁰

Nearly half of mothers lack sufficient knowledge about preventing hypothermia, according to a cross-sectional study on the topic conducted by Indu Shah et al. among 70 mothers of newborns. ¹¹

In the SNCU of M.K.C.G Medical College Hospital, 54 mothers of low birth weight neonates participated in a study by Sadhana Panda et al. on their understanding of preventing newborn hypothermia. Just 44% of mothers believed that drying the infant right after would stop heat loss, and only 11% of mothers knew enough about skin-to-skin contact, the most effective way to stop heat loss. ¹²

According to a study by Ahmed et al. in three hospitals in the state of Khartoum, only 52.66% of mothers were in favour of treating newborn hypothermia symptoms as soon as they appeared. ¹³

A research by Kibaru et al. in the Nakuru Central district of Kenya found that just 9.7% of mothers recognised hypothermia as a potential danger sign for their newborn. ¹⁴ According to a research conducted in rural Bangladesh by Zaman et al., hypothermia was the infant risk indication that newly delivered women (RDW) identified the least often(26.1%). ¹⁵

Smita Srivastava et al.’s randomised control trial found that skin-to-skin contact during the initial postpartum period is associated with improved neonatal temperature regulation. ¹⁶ Focused interventions reduced the average monthly risk of hypothermia among low birth weight and late preterm neonates to 13.3%, according to research by Christine Andrews et al. Prior to this, the average monthly rate of hypothermia was 29.8%. ¹⁷

Infants who did not receive their mothers’ first skin-to-skin contact during delivery had a 4.3-fold increased risk of developing hypothermia, as per research by Demissie et al. ¹⁸

To determine how well kangaroo mother care (KMC) works to keep low birth weight babies warm while being transported from the hospital to their families, Nimbalkar et al. undertook a study. After being discharged from the hospital, the study group experienced a mean rise in temperature of 0.01°C, whereas the control group saw an average decrease in temperature of 0.07°C during transportation. ¹⁹

As part of the intervention plan for their study, Noel Joseph et al. added a number of interventions, such as key cards, hypothermia algorithms, and nursing education. Following implementation, the mother-baby unit’s incidence of hypothermia dramatically decreased, falling from 20.9% to 14.5%. Furthermore, there were 71% fewer newborns who required admission to the Neonatal Intensive Care Unit (NICU). ²⁰

Mukunya et al.’s multivariable analysis revealed that delayed breastfeeding initiation, low birth weight and home birth were the variables linked to a higher risk of newborn hypothermia. ²¹

According to a study by Olawuyi et al., nearly two thirds (66.7%) of mothers in newborn intensive care units were aware of the advantages of Kangaroo Mother Care (KMC). ²²

In a research by S P Choudhary et al., which involved medical and paramedical personnel, only 47.8% of the participants correctly defined newborn hypothermia, and a noteworthy 52.2% thought it was an uncommon problem. ²³

In the early postpartum period, when neonates are most susceptible to hypothermia, the warm chain was not continuously maintained, according to a study by Karsten Lunze et al done in rural Zambia. ²⁴

Within the first five minutes of birth, 27% of newborns were wrapped and 42% of neonates were dried, according to a study conducted in rural southern Tanzania by Donat Shamba et al. The fact that carers neglected to tend to the baby until after the placenta was delivered was the main cause of the delay in wrapping and drying. ²⁵

Early newborn washing was practiced by 87.5% of women who did not visit health facilities for ANC, compared to 54.8% of moms who had four or more ANC visits, according to Gebrew Getachew et al. ²⁶

The results of a study by Luke Mullany et al showed that infants whose breastfeeding was delayed for longer than 24 hours were almost 50% more likely to experience hypothermia. ²⁷ According to a research by Meseret Ekubay et al, 58.3% of mothers started breastfeeding their newborns in the first hour following birth. ²⁸

According to Golicha Wako et al., out of 388 mothers in South Ethiopia, 69.1% of them covered their newborns’ heads right away after delivery, and almost all of them did so for duration of the neonatal period. ²⁹

Dongre et al undertook a study to determine how well-informed mothers in periurban Wardha were about infant warning signs. Just 2.8% of respondents identified hypothermia in neonates as one of the warning indicators. ³⁰

In health education, video based learning provides an effective teaching medium for knowledge acquisition, skill development, and attitude modification, according to a systematic review and meta analysis by Mariano Margado et al. Video based learning leads to substantial improvement in medical awareness. ³¹

No study has been conducted which shows the efficacy of a simple video based educational intervention on preventing neonatal hypothermia. In line with pertinent theories of attitude change and health behavior, video-based learning exhibits promise in the field of health education. ³¹ This study will show the effectiveness of a video based educational tool in educating mothers and will be useful for the primipara mothers to gain adequate knowledge about preventing neonatal hypothermia.

Table 1 depicts the demographic information of study participants. In our study there were a total of 124 participants, out of which 50% belonged to the intervention group.

51 participants had number of family members ranging between 1-5 (82.3%) and rest had between 6-10 (17.7%). Majority of them had a normal vaginal delivery (58.1%) and delivered a term baby (96.8%). Out of the 62 mothers in the intervention group, 59 participants had number of family members ranging between 1-5 (95.2%) and 3 participants had between 6-10 (4.8%). Majority of the study participants in the intervention group had studied up to higher secondary (41.9%). Majority of them had a cesarean section (66.1%) and delivered a term baby (98.4%).

Of the 124 moms who took part in our study, 97.6% of them gave birth to a term child. The intervention increased mothers’ knowledge from 24.2% to 71.0% regarding how to maintain their baby’s body heat. Mothers in the intervention group knew when to start breastfeeding at a rate of 85.5%, compared to just 24.2% of mothers in the control group.

Following the intervention, mothers’ practices for controlling the newborn’s body temperature, maintaining skin-to-skin contact, and exclusively breastfeeding showed considerable improvement. In the control group, 75.8% of mothers were unaware of the appropriate time to start breastfeeding. 85.5% of mothers knew when to start breastfeeding their newborn after the intervention.

In the post-intervention group, 98.4% of mothers wore a cap over their baby’s head, compared to just 35.5% in the control group. Mothers’ knowledge and practices towards preventing neonatal hypothermia have improved as a result of the intervention, as seen by improvements in exclusive breastfeeding and newborn thermal care.

The demographic information in our study is depicted in Table 1. In the control group, 5 of them were between the ages of 15-20 years (0.08%), 29 were between 21-25 years of age (46.7%), 19 were between 26-30 years of age (30.6%) and 9 were between 31-35 years of age (14.5%). 51 participants belonged to family size of 1-5 members (82.3%) and 11 participants belonged to a family size of 6-10 (17.7%). Majority of them had studied between 1 ^st – 10 ^th std (46.8%) and had a family income of Rs.5000-10000 (67.7%) in the control group. Majority of them had a normal vaginal delivery (58.1%) and delivered a term baby (96.8%). Majority of the newborns in the control group were females (56.5%). Out of the 62 newborns in the control group, 6 had a birth weight ranging between 1-1.9 kg (9.7%), 30 between 2-2.9 kg (48.4%) and 26 between 3-3.9 kg (41.9%).

In the intervention group, 3 of them were between the ages of 15-20 years (4.8%), 27 were between 21-25 years of age (43.5%), 24 were between 26-30 years of age (38.7%) and 8 were between 31-35 years of age (12.9%). 59 participants had number of family members ranging between 1-5 (95.2%) and 3 participants had between 6-10 (4.8%). Majority of the study participants in the intervention group had studied up to higher secondary (41.9%) and had a family income of Rs.10000-15000 (54.8%). Majority of them had a cesarean section (66.1%) and delivered a term baby (98.4%). Majority of the newborns in the intervention group were males (64.5%). Out of the 62 newborns in the intervention group, 2 had a birth weight ranging between 1-1.9 kg (3.2%), 39 between 2-2.9 kg (62.9%) and 21 between 3-3.9 kg (33.9%).

Table 2 shows the analysis of mothers’ knowledge about preventing newborn hypothermia. Among the control group, a significant 96.8% of the mothers did not know which part of the baby's body should be covered to conserve heat. 91.9% of them did not know which part of the body is most susceptible to heat loss. Additionally, 90.3% could not identify the body part that will become cold when the baby loses heat. This indicates that majority of the mothers lack knowledge regarding three main contributing factors of hypothermia: the importance of covering the baby to conserve heat, identifying the areas of maximum heat loss, and recognizing which body parts need to be checked for hypothermia. This shows that the predominant cause of neonatal hypothermia can be prevented if the mothers had knowledge on how it occurs, how to check for it, and how to prevent it. Furthermore, 79.0% of them also did not know the proper method to dry the baby after bath. It suggests that they were unaware that bathing significantly reduce the body temperature and if the baby is not adequately dried, it can predispose to hypothermia. Moreover, 75.8% did not know how to maintain the body heat of the baby, and similarly, 75.8% of them did not know how often to change the baby's soiled clothes or diaper. This is brings to light, another easily preventable cause of neonatal hypothermia. If the mothers were made aware, that soiled clothes can cause hypothermia, they will change the soiled clothes immediately which can significantly reduce hypothermia.

Additionally, 75.8% of them did not know when breast feeding should be initiated in the newborns. 71% of the mothers were unaware of the ideal time of the day to bathe the baby. Notably, 64% of the mothers used benzoin resin fumes to dry the baby. These questions help address the fundamental aspects in preventing hypothermia. Highlighting and educating mothers about the timely initiation of breastfeeding, right time to bathe the baby, and risks of using benzoin resin to dry the baby, can help to formulate effective practices aimed at preventing hypothermia. Moreover, 59.7% of the mothers also did not know how often to breastfeed the baby, and a similar percentage of 59.7% did not know how often the weight of the baby must be checked. This highlights that the lack of maternal knowledge was the primary factor for the occurrence of neonatal hypothermia, which can otherwise be easily detected.

However, 96.8% of them knew the best practices to maintain body heat immediately after birth and 95.2% understood preferred bathing method for the newborn. This information suggests that the majority of the mothers understood the significance of maintaining the body temperature immediately after birth. Furthermore, 83.9% of the mothers also knew the ideal time for baby’s first bath. This indicates that most of the mothers had knowledge about the effects of bathing on body temperature and how hypothermia can be prevented by knowing the ideal time for the first bath of the baby.

In the intervention group we can see a significant improvement in the knowledge where 100% of the mothers now understood which part of the baby’s body is prone to maximum heat loss (p-value = 0.000), which body parts become cold when the baby loses heat (p-value= 0.12), the ideal time for first bath of the baby (p-value = 0.001), the type of bath that is preferred for the newborn (p-value = 0.080), and the most effective methods to maintain body heat immediately after birth (p-value = 0.154). Additionally,98.4% of the mothers knew the right part of the baby's body that must be covered mainly to conserve heat (p-value = 0.000). Furthermore, 95.2% of the mothers knew that benzoin resin fumes should not be used to dry the baby (p-value = 0.000) after the education session. A significant 85.5% knew the right time to initiate breast feeding in the newborn (p-value = 0.000). Again, 80.6% knew how frequently the weight of the baby should be checked after delivery (p-value = 0.000) and 77.4% knew the correct frequency of breastfeeding (p-value = 0.000). In this group, 72.6% of the mothers were aware of the right method to dry the baby after bathing (p-value = 0.000). after the intervention, 71.0% of the mothers also knew how to maintain the body heat of the baby (p-value = 0.000). Notably, 67.7% of the mothers knew how often a baby's soiled clothes or diapers needed to be changed (p-value = 0.000). Lastly, 64.5% of the mothers in this group knew the right time of the day to bathe the baby (p-value = 0.000). Responses to questions on ideal time of the day for baby’s bath, changing soiled diapers and breastfeeding in Table 2 were similar to responses found by Leilane Barbosa de Sousa et al on their study on effect of educational video on newborn care knowledge among mothers. ³² Knowledge of mothers about newborn’s first bath, drying the baby and initiation of breastfeeding in Table 2 were similar to results found in a study by Richard Mangwi et al. ³³

Table 3 shows the assessment of mothers’ newborn practices. In the control group, all 100% of the mothers were noted to not wash hands prior to breastfeeding which is a significant finding. This highlights the importance of educating the mothers regarding possible infections and sepsis of the baby which can lead to hypothermia. Notably, 95.2% of mothers do not check the baby's abdomen and legs for heat loss. This implies that there is a significant lack of knowledge on how to check the baby for hypothermia. A majority of 90.3% of the mothers also failed to clean the breast before breastfeeding the baby. This again highlights the lack of knowledge regarding the possibility of the baby acquiring an infection. Furthermore, 77.4% of the mothers failed to dress the baby with a shirt, cap, gloves, socks, nappy, and wrap with towel. A considerable 64.5% of mothers did not cover the baby’s head with a cap. This underscores the importance of educating the mothers about appropriate clothing and covering to prevent heat loss in the babies. However, in 98.4% of the mothers, most of the areola and nipple were positioned effectively while feeding the baby. This implies that mothers knew the correct positioning of the baby for breastfeeding.

In the intervention group. 100% of the mothers knew that most of the areola and nipple must be inside the baby’s mouth while feeding (p-value = 0.315), and 100% of the mother and baby shared the same bed (p-value = 0.001). This demonstrates the key changes in the post intervention group were right positioning of the baby while breastfeeding and rooming in was achieved in all the mothers. Notably, 98.4% of them knew about covering the baby’s head with a cap after the intervention (p-value = 0.000). Additionally, 83.9% of them provide exclusive breastfeeding to the baby (p-value = 0.086). This has helped in implementing a very important practice of exclusive breast feeding. Furthermore, in this group, 74.2 % of the mothers now knew to check the baby’s abdomen and legs for heat loss (p-value = 0.000). This suggests that the video based educational session has had a significant impact in educating the mothers on early detection of hypothermia. These findings underscore the efficacy of the video based intervention which has improved the mothers understanding of the causes, identification, and preventive practices of neonatal hypothermia. However, only 54.8% of the mothers cleaned the breast before breastfeeding even after the educational intervention (p-value = 0.000). This underlines the importance of repeated counselling to reemphasize the importance of hygienic practices while breast feeding. In this group, 53.2% of the mothers now knew to dress the baby with a shirt, cap, gloves, socks, nappy, and wrap with towel (p-value = 0.000). Moreover, 82.3% of the mothers still did not wash their hands before feeding the baby even after the educational intervention (p-value = 0.001). Nevertheless,100% of the babies slept soundly after feeding in both groups, indicating that the babies were receiving adequate breastfeeding which ensured good sleep.

Practices regarding adequately covering the baby, identifying danger signs of neonatal hypothermia and adequate breastfeeding were similar to results found by Swathi Eluri et al. ³⁴ Practices of mothers on skin to skin contact, exclusive breastfeeding and hygienic breastfeeding practices in Table 3 were comparable to results found by Laura Subramanian et al. ³⁵ Intervention group had better exclusive breastfeeding practices as compared to control group, but not statistically significant. This data indicates that the mothers were practicing exclusive breastfeeding and an intervention is not required for that. This finding was similar to results found by B. Adhisivam et al in a study assessing the impact of a video based health education program. ³⁶

The results of this study demonstrate the significant improvement in mothers’ knowledge and practices about the prevention of neonatal hypothermia due to the use of a video-based educational tool. Consequently, it will result in a decrease in mortality and morbidity rates of neonates related to hypothermia.

The Institutional Ethics Committee at Kasturba Medical College in Mangalore has granted ethical clearance on 16/03/23 (Protocol No: IECKMCMLR-03/2023/94). We have received approval from the Government Lady Goschen Hospital’s Medical Superintendent to carry out this research.

Informed written consent for participation in the study was obtained.