Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study

Abstract

<jats:title>Abstract</jats:title> <jats:p>Background The objective of this study was to evaluate the association between admission hypothermia and neonatal outcomes in very low-birth weight (VLBW) infants in multiple neonatal intensive care units (NICUs) in China. Methods Since January 1, 2018, a neonatal homogeneous cooperative research platform has been established. The platform collects clinical data in a prospective manner on preterm infants with birth weights (BWs)&lt;1500 g and gestational ages (GAs)&lt;34 weeks born in 28 NICUs in Shandong Province. These infants were divided into normothermia, mild or moderate/severe hypothermia groups according to the World Health Organization (WHO) classifications of hypothermia. Associations between outcomes and hypothermia were tested in a bivariate analysis, followed by a stepwise logistic regression analysis. Results A total of 1247 VLBW infants were included in this analysis, of which 1100 infants (88.2%) were included in the hypothermia group, 554 infants (44.4%) in the mild hypothermia group and 546 infants (43.8%) in the moderate/severe hypothermia group. Small for gestational age (SGA), caesarean section, a low Apgar score at 5 min and intubation in the delivery room (DR) were related to admission hypothermia (AH). Mortality was the lowest when their admission temperature was 36.5~37.5°C, and after adjustment for maternal and infant characteristics, mortality was significantly associated with AH. Compared with infants with normothermia (36.5~37.5°C), the adjusted ORs of all deaths increased to 4.148 (95% CI 1.505-11.437) and 1.806 (95% CI 0.651-5.009) for infants with moderate/severe hypothermia and mild hypothermia, respectively. AH was also associated with a high likelihood of respiratory distress syndrome (RDS), intraventricular haemorrhage (IVH), and late-onset neonatal sepsis (LOS). Conclusions AH is still very high in VLBW infants in NICUs in China. SGA, caesarean section, antenatal steroid use, a low Apgar score at 5 min and intubation in the DR were associated with increased odds of hypothermia. Moderate/severe hypothermia was associated with mortality and poor outcomes, such as RDS, IVH, LOS, etc.</jats:p>

Admission Hypothermia and Factors Associated with Mortality among Admitted Hypothermic Preterm Neonates in Neonatal Intensive Care Units of Public Hospitals of Addis Ababa, Ethiopia

“…We show that the proportion of admission hypothermia was 83.17%. This finding was consistent with a multicountry study (China (88.2%) [12], Malawi (77%) [8], and Korea (74.3%) [14], but higher than the study conducted in Ghana [10] and different parts of Ethiopia [18,20,22,23]. Moreover, the obvious reasons of sample size, study participants and study period differences, temperature measurement time, differences in hospital setups (equipment available and skilled personnel), and socioeconomic differences across regions might be the possible explanation for the discrepancy.…”

“…According to this study's finding, hypothermic very preterm and VLBW babies had a greater chance of mortality compared to term and normal birth weight preterm infants. This finding has also been reported in other settings [7,8,12]. This is because babies with small gestational age or birth weight have a large surface area per unit of body weight, immature hypothalamic thermal control, immature and thin skin, and low subcutaneous and brown fat.…”

“…In Ethiopia, hypothermia was the most common neonatal contributory cause; being present in (69.4%) of all neonatal deaths [11]. To the author's best knowledge, only a few studies assessed the relationship between admission hypothermia and neonatal morbidity and mortality [7,8,[12][13][14]. Evidence-based analysis revealed that prevention and management of hypothermia could reduce 18%-42% of all-cause neonatal mortality or morbidity, globally [15].…”

Decreased moderate admission hypothermia in extremely preterm newborns

“…In contrast, mild hypothermia (36.0–36.4 °C) was observed in 33% of our EPNs. The rate of 13% with severe‐to‐moderate hypothermia in our study was much lower than the 52% and 44% in O'Brien's and Yu's studies, respectively, consisting of VLBW newborns 9,13 . However, our total rate of moderate‐to‐mild admission hypothermia (32.0–36.4 °C) of 45% was comparable with the 41% in Laptook's study consisting of 3,213 preterm newborns at <29 weeks of gestation 10 .…”

Incidence, time to recovery and predictors among neonates admitted with respiratory distress to the neonatal intensive care unit at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021

“…This result showed that hypothermic neonates admitted with RD had 39% delayed recovery compared with those not hypothermic with RD. Studies in China [ 27 ] and Iran [ 28 ] supported this evidence that hypothermia with RD leads to increased oxygen consumption, which leads to hypoxemia, which in turn leads to pulmonary vasoconstriction, the reduced release of pulmonary surfactant and decreased work by respiratory muscles, increasing respiratory distress that delayed recovery. Respiratory distressed neonates with hypothermia, on the other hand, had a lower average gestational age and birth weight, as well as a higher likelihood of having a low Apgar score and an early-onset infection, resulting in a longer recovery time [ 29 ].…”