Association between admission temperature and mortality and major morbidity in very low birth weight neonates – single center prospective observational study

Sharma, Deepak; Murki, Srinivas; Pratap, Tejo; Deshbotla, Sai Kiran; Vardhelli, Venkateshwarlu; Pawale, Dinesh; Kulkarni, Dattatray; Arun, S.; Bashir, Tanveer; Anne, Rajendra Prasad

doi:10.1080/14767058.2020.1810229

Cited by 11 publications

(16 citation statements)

References 25 publications

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“…However, intrauterine growth restriction in very preterm infants is a serious condition that could hinder the achievement of postnatal growth potential 13 . Infants with more severe illness or younger gestational age have longer NICU stay and are more likely develop EUGR 14,15 . This is consistent with a previous long‐term cohort study of very preterm infants, in which the EUGR incidence was found to be higher in SGA infants than in non‐SGA infants 10 .…”

Section: Discussionsupporting

confidence: 88%

Evaluation of nutrition status of very preterm infants in neonatal intensive care units using different growth indicators

Wang

Jia

et al. 2021

Nut in Clin Prac

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Background Nutrition status of very preterm infants in the neonatal intensive care unit (NICU) is strongly associated with postnatal growth. This study aimed to develop indicators of nutrition status using growth data of very preterm infants during hospitalization. Methods The data of 596 newborns from eight NICUs were retrospectively analyzed. Inclusion criteria were birth at <32 weeks’ gestation, NICU admission ≤24 h after delivery, and length of hospital stay ≥28 days. Three indicators were evaluated: (indicator I) prevalence of extrauterine growth restriction (EUGR); (indicator II) z‐score for change in weight from birth to discharge, adjusted for birth weight z‐score and gestational age; and (indicator III) change in weight z‐score from birth to discharge, adjusted for birth weight z‐score, gestational age, and time to regain birth weight. Using data from NICU 1 as the reference for the latter two indicators, we established linear regression models of the adjusted change in weight z‐score from birth to discharge. The difference between the observed value and the baseline value (calculated by the two models) served as the nutrition indices. Results The prevalence of EUGR differed significantly between the eight NICUs (P = .009). Statistically significant differences were found between the mean indices calculated by the other two models (all P < .05). Conclusions Indicator III, change in weight z‐score from birth to discharge (adjusted for birth weight z‐score, gestational age, and time to regain birth weight), appears to be the most accurate for evaluating the quality of nutrition in the NICU.

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Section: Discussionsupporting

confidence: 88%

Evaluation of nutrition status of very preterm infants in neonatal intensive care units using different growth indicators

Wang

Jia

et al. 2021

Nut in Clin Prac

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“…It is well established that hypothermia on admission to the neonatal unit is an independent predictor of mortality in preterm babies. This association continues to be described in the recent literature from many countries including UK [1], Europe [2], North America [3,4] and India [5]. Recommendations for optimal admission temperature at preterm birth include avoidance of both hypothermia and hyperthermia.…”

Section: Introductionmentioning

confidence: 83%

Very Low Birth Weight Outcomes and Admission Temperature: Does Hyperthermia Matter?

2022

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National and international recommendations for thermal care at preterm birth include recommendations to avoid hypothermia and hyperthermia. There is limited evidence demonstrating harm resulting from admission hyperthermia. Our aim was to assess the relationships between admission temperature and outcomes in very low birth weight (VLBW) babies in a unit with low rates of hypothermia and a higher rate of hyperthermia. This was an observational study based on routinely collected data including demographics, admission temperature, survival and major morbidity outcomes. Subjects were 1104 consecutive inborn VLBW babies admitted to a Neonatal Intensive Care Unit in United Kingdom between 2010 and 2017. Results: 155 (14%) of babies were hypothermic (<36.5 °C) with only 21 (1.9%) < 36 °C, and 254 (23%) of babies were hyperthermic (>37.5 °C). The rate of major abnormality on cranial ultrasound scan was increased in the hyperthermic babies compared to the normothermic babies (37/239 (15.5%) vs. 54/601 (9%), relative risk (95% CI) 1.723 (1.166 to 2.546), p = 0.006). There was no difference in survival or other major morbidity in the hyperthermic babies compared to the normothermic babies. There was no association between hypothermia and survival or any major morbidity, although this probably reflects the low power of the study given the low rates of significant hypothermia. Higher admission temperature was associated with an increase in the risk of major cranial ultrasound abnormality using multiple logistic regression analysis (p = 0.007) with an increased odds ratio (95% CI) of 1.48 (1.11 to 1.97) for each degree of increase. We conclude that admission hyperthermia is independently associated with an increased risk of preterm brain injury. It is not possible to state whether this is a causative association, or whether the association is a consequence of a shared aetiology of perinatal infection.

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“…These infants are at increased risk of serious complications from hypothermia and hyperthermia. 6 , 10 , 11 Strategies suggested by international resuscitation guidelines to maintain normothermia in preterm infants include keeping the ambient temperature of the birthing environment above 23 °C, wrapping the infant in a polyethylene bag/wrap, using an exothermic heating mattress, and using heated humidified gases at resuscitation. 5 , 12 In this survey, the use of a polyethylene bag or wrap was the most consistent practice for thermoregulation.…”

Section: Discussionmentioning

confidence: 99%

Thermoregulation and golden hour practices in extremely preterm infants: an international survey

et al. 2022

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Background Are thermoregulation and golden hour practices in extremely preterm (EP) infants comparable across the world? This study aims to describe these practices for EP infants based on the neonatal intensive care unit’s (NICUs) geographic region, country’s income status and the lowest gestational age (GA) of infants resuscitated. Methods The Director of each NICU was requested to complete the e-questionnaire between February 2019 and August 2021. Results We received 848 responses, from all geographic regions and resource settings. Variations in most thermoregulation and golden hour practices were observed. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission, and having local protocols were the most consistent practices (>75%). The odds for the following practices differed in NICUs resuscitating infants from 22 to 23 weeks GA compared to those resuscitating from 24 to 25 weeks: respiratory support during resuscitation and transport, use of polyethylene plastic wrap and servo-control mode, commencing ambient humidity >80% and presence of local protocols. Conclusion Evidence-based practices on thermoregulation and golden hour stabilisation differed based on the unit’s region, country’s income status and the lowest GA of infants resuscitated. Future efforts should address reducing variation in practice and aligning practices with international guidelines. Impact A wide variation in thermoregulation and golden hour practices exists depending on the income status, geographic region and lowest gestation age of infants resuscitated. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission and having local protocols were the most consistent practices. This study provides a comprehensive description of thermoregulation and golden hour practices to allow a global comparison in the delivery of best evidence-based practice. The findings of this survey highlight a need for reducing variation in practice and aligning practices with international guidelines for a comparable health care delivery.

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Association between admission temperature and mortality and major morbidity in very low birth weight neonates – single center prospective observational study

Cited by 11 publications

References 25 publications

Evaluation of nutrition status of very preterm infants in neonatal intensive care units using different growth indicators

Evaluation of nutrition status of very preterm infants in neonatal intensive care units using different growth indicators

Very Low Birth Weight Outcomes and Admission Temperature: Does Hyperthermia Matter?

Thermoregulation and golden hour practices in extremely preterm infants: an international survey

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