Management and Clinical Outcomes of Neonatal Hypothermia in the Newborn Nursery

Abstract

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.