Factors associated with hypothermia within the first 6 hours of life in infants born at ≥340 weeks’ gestation: a multivariable analysis

Nguyen, Laura; Mitsakakis, Nicholas; Sucha, Ewa; Lemyre, Brigitte; Lawrence, Sarah

doi:10.1186/s12887-022-03512-x

Cited by 7 publications

(24 citation statements)

References 28 publications

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“…This aligns with temperature measurement practices at the Lucile Packard Children’s Hospital Stanford (LPCHS) nursery in Palo Alto, California, where an infant’s temperature is measured up to 9 times in the first 24 hours after birth . A retrospective study from Canada conducted in 440 infants with greater than or equal to 34 weeks’ gestation found that 26.8% of the infants had hypothermia (temperature <36.5 °C) in the first 6 hours after birth and that risk factors for hypothermia were similar to those identified in studies in preterm and low BW infants . With universal attention to thermoregulation and routine temperature measurement, and well newborn care accounting for such a large part of pediatric care, it is critical to understand the epidemiologic factors of neonatal hypothermia in the nursery setting to support the advancement of evidence-based care surrounding temperature measurement and neonatal hypothermia.…”

Section: Introductionmentioning

confidence: 53%

“…A retrospective study mentioned in the Introduction found a slightly higher hypothermia incidence of 26.8%, although that study included sicker infants admitted directly to the NICU and considered only hypothermia in the first 6 hours following birth, including hypothermia in the delivery room. 10 Two quality improvement studies in the newborn nursery were able to reduce…”

Section: Discussionmentioning

confidence: 99%

“…To examine factors associated with neonatal hypothermia, we a priori selected maternal and infant risk factors based on relevant literature. 4,5,10,[12][13][14] Maternal factors included age, parity, maternal fever, mode of delivery, race and ethnicity, primary spoken language, and insurance status.…”

Section: Outcomes and Risk Factorsmentioning

confidence: 99%

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Incidence of Neonatal Hypothermia in the Newborn Nursery and Associated Factors

Dang,

Patel,

Weng

et al. 2023

JAMA Netw Open

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ImportanceThermoregulation is a key component of well-newborn care. There is limited epidemiologic data on hypothermia in late preterm and term infants admitted to the nursery. Expanding on these data is essential for advancing evidence-based care in a population that represents more than 3.5 million births per year in the US.ObjectiveTo examine the incidence and factors associated with hypothermia in otherwise healthy infants admitted to the newborn nursery following delivery.Design, Setting, and ParticipantsA retrospective cohort study using electronic health record data from May 1, 2015, to August 31, 2021, was conducted at a newborn nursery at a university-affiliated children’s hospital. Participants included 23 549 infants admitted to the newborn nursery, from which 321 060 axillary and rectal temperature values were analyzed.ExposuresInfant and maternal clinical and demographic factors.Main Outcomes and MeasuresNeonatal hypothermia was defined according to the World Health Organization threshold of temperature less than 36.5 °C. Hypothermia was further classified by severity (mild: single episode, temperature 36.0-36.4 °C; moderate/severe: persistent or recurrent hypothermia and/or temperature &lt;36.0 °C) and timing (early: all hypothermic episodes occurred within the first 24 hours after birth; late: any episode extended beyond the first 24 hours).ResultsOf 23 549 included infants (male, 12 220 [51.9%]), 5.6% were late preterm (35-36 weeks’ gestation) and 4.3% were low birth weight (≤2500 g). The incidence of mild hypothermia was 17.1% and the incidence of moderate/severe hypothermia was 4.6%. Late hypothermia occurred in 1.8% of infants. Lower birth weight and gestational age and Black and Asian maternal race and ethnicity had the highest adjusted odds across all classifications of hypothermia. The adjusted odds ratios of moderate/severe hypothermia were 5.97 (95% CI 4.45-8.00) in infants with a birth weight less than or equal to 2500 vs 3001 to 3500 g, 3.17 (95% CI 2.24-4.49) in 35 week’ vs 39 weeks’ gestation, and 2.65 (95% CI 1.78-3.96) in infants born to Black mothers and 1.94 (95% CI 1.61-2.34) in infants born to Asian mothers vs non-Hispanic White mothers.Conclusions and RelevanceIn this cohort study of infants in the inpatient nursery, hypothermia was common, and the incidence varied by hypothermia definition applied. Infants of lower gestational age and birth weight and those born to Black and Asian mothers carried the highest odds of hypothermia. These findings suggest that identifying biological, structural, and social determinants of hypothermia is essential for advancing evidence-based equitable thermoregulatory care.

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Section: Introductionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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Incidence of Neonatal Hypothermia in the Newborn Nursery and Associated Factors

Dang,

Patel,

Weng

et al. 2023

JAMA Netw Open

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“…A study in Denmark found that neonates with hypothermia had an increase odds of having respiratory distress syndrome and bronchopulmonary dysplasia, however when these results were adjusted for confounders the findings were not significant ( 9 ). Complications of respiratory distress syndrome, need for respiratory support and an increase in admission to the NICU or standard care nursery are seen with a higher prevalence in neonates who are hypothermic ( 10 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that neonates who are small for gestational age or low birthweight are more prone to hypothermia. Reasons cited for this are large head to body surface area and decreased insulation due to decreased body fat ( 10 ). Surprisingly neonates with IUGR were less likely to be hypothermic in this study although the group sizes for this comparison were very small.…”

Section: Discussionmentioning

confidence: 99%

Hypothermia in neonates born by caesarean section at a tertiary hospital in South Africa

et al. 2022

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Introductionneonatal hypothermia has previously been noted in a large proportion of neonates born through Caesarean section at Chris Hani Baragwanath Hospital (CHBAH), yet no study in South Africa specifically explores the extent and severity of the threat of hypothermia to this population of neonates.Objectivesto describe the proportion and severity of neonatal hypothermia in infants born via Caesarean section at CHBAH as well as to document and describe possible contributing factors to neonatal hypothermia in this population.MethodsA neonatal unit's database records were reviewed for demographic information of patients and their mothers, clinical characteristics, body temperature and outcomes. Comparisons between normothermic and hypothermic neonates were performed.ResultsForty-one percent of neonates born via Caesarean section had hypothermia at birth, of whom 71%, 27% and 2% had mild, moderate and severe hypothermia, respectively. Prevalence of admission hypothermia was 42%. On average, neonates were born at term and were of normal birth weight. No maternal factors were found to be statistically significant. Bag-mask ventilation (BMV) and cardiopulmonary resuscitation (CPR) [3.4% vs. 0.7%, p-0.033; OR 2.67 (95% CI: 1.06–6.77)] and an elevated lactate [13.25 vs. 3.2 mmol/l, p-0.032; OR 1.13 (95% CI: 1.01–1.26)] were associated with hypothermia. In the multivariable logistic regression analysis hypothermia in neonates was associated with an elevated lactate.ConclusionsPrevalence of hypothermia in neonates born by Caesarean section is high and further prospective studies are required to elucidate the factors contributing to this.

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Management and Clinical Outcomes of Neonatal Hypothermia in the Newborn Nursery

Dang,

Patel,

Weng

et al. 2023

Preprint

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Background and ObjectivesNeonatal hypothermia has been shown to be commonly detected among late preterm and term infants. In preterm and very low birth weight infants, hypothermia is associated with increased morbidity and mortality. Little is known about the clinical interventions and outcomes in hypothermic late preterm and term infants. This study fills this gap in the evidence.MethodsSingle-center retrospective cohort study using electronic health record data on infants ≥35 weeks’ gestation admitted to a newborn nursery from 2015-2021. Hypothermia was categorized by severity: none, mild (single episode, 36.0-36.4°C), and moderate/severe (recurrent episodes and/or <36.0°C). Bivariable and multivariable logistic regression examined associations between hypothermia and interventions/outcomes. Stratified analyses by effect modifiers were conducted when appropriate.ResultsAmong 24,009 infants, 1,111 had moderate/severe hypothermia. These hypothermic infants had higher odds of NICU transfer (aOR 2.10, 95% CI 1.68-2.60), sepsis evaluation (aOR 2.23, 95% CI 1.73-2.84), and antibiotic use (aOR 1.73, 95% CI 1.15-2.50) than infants without hypothermia. No infants with hypothermia had culture-positive sepsis and receipt of antibiotics ≥72 hours (surrogate for culture-negative sepsis and/or higher severity of illness) was not more common in hypothermic infants. Hypothermic infants also had higher odds of blood glucose measurement and hypoglycemia, higher percent weight loss and longer lengths of stay.ConclusionLate preterm and term infants with hypothermia in the nursery have potentially unnecessary increased resource utilization. Evidence-based and value-driven approaches to hypothermia in this population are needed.What’s Known on This SubjectNeonatal hypothermia has been associated with morbidity and mortality in high-risk (preterm and very low birth weight) infants. The clinical implications of hypothermia in otherwise healthy late preterm and term infants admitted to the newborn nursery are poorly defined.What This Study AddsInfants with moderate/severe hypothermia have higher odds of diagnostic interventions and NICU transfers than infants without hypothermia. No infants with hypothermia had culture-positive sepsis. With the lack of a strong evidence base, hypothermia may drive unnecessary resource overutilization.

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Factors associated with hypothermia within the first 6 hours of life in infants born at ≥340 weeks’ gestation: a multivariable analysis

Cited by 7 publications

References 28 publications

Incidence of Neonatal Hypothermia in the Newborn Nursery and Associated Factors

Incidence of Neonatal Hypothermia in the Newborn Nursery and Associated Factors

Hypothermia in neonates born by caesarean section at a tertiary hospital in South Africa

Management and Clinical Outcomes of Neonatal Hypothermia in the Newborn Nursery

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