Outcomes of neonatal hypothermia among very low birth weight infants: a Meta-analysis

Mohamed, Sarajul Fikri; Ahmed, Sara Hassan Hassan; Khidir, Reem Jamal Yousif; Shaheen, Mutaz T.; Adam, Mosab; Ibrahim, Basil; Elmahdi, Esra Osama Abdelrahman; Farah, Abubaker Shadoul Mohamed

doi:10.1186/s40748-021-00134-6

“…While hypothermia has been associated with high rates of mortality in the adult and neonatal intensive care unit literature, the prevalence and prognosis for previously healthy infants with hypothermia has yet to be quantified 17–24 . Therefore, guidelines regarding the management of hypothermic infants presenting to the ED are lacking.…”

Section: Discussionmentioning

confidence: 99%

“…mia has yet to be quantified. [17][18][19][20][21][22][23][24] Therefore, guidelines regarding the management of hypothermic infants presenting to the ED are lacking. | 43…”

Section: Discussionmentioning

confidence: 99%

The prevalence for the risk of serious infection in hypothermic infants ≤ 60 days: A systematic review

Delaney

¹

,

Bober

²

,

Koos

³

et al. 2022

Academic Emergency Medicine

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Background Temperature abnormalities in infants may be a sign of a serious infection (SI) and there is literature regarding the workup of the febrile infant to help guide management. The prevalence of SIs in hypothermic infants and the development of established guidelines for this population has not been established. Our primary objective was to determine the prevalence of SI in hypothermic infants who are 60 days old or younger presenting to the emergency department (ED). In addition, we calculated the prevalence of SI by organ system and identified its microorganism. Methods We performed a systematic review by searching the literature in Medline, Embase, Web of Science, and CINAHL. We limited our search to infants ≤ 60 days with a rectal temperature <36.5°C who presented to the ED. We defined SI as bacteremia, urinary tract infection (UTI), meningitis, herpes simplex virus infections, or pneumonia. We calculated the prevalence of SI. Quality of studies and bias was assessed using QUADAS‐2. Our study was registered with PROSPERO, 2020 CRD42020153477. Results We identified 1242 articles from our initial search in December 2019 followed by a second search in February 2021 to capture any recent publications. We identified four studies meeting our inclusion criteria. We estimated the prevalence of SI as 4.86% (95% confidence Interval [CI] 1.97–8.82) for infants ≤ 60 days old. In a subgroup analysis of infants ≤ 28 days (n = 16/374), we estimated the prevalence of SI as 5.15 (95% CI 0.95–12.0). The most common source for SI was UTI, with a prevalence of 2.16% (95% CI 1.18–3.60). Conclusion The overall prevalence of SI was 4.86% in hypothermic young infants ≤ 60 days old presenting to the ED. Infants ≤ 28 days had a slightly higher prevalence of 5.15%. The most common source for serious bacterial infection was UTI.

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“…This statistically significant association between thrombocytopenia and hospital mortality reaffirms the importance of early diagnosis and management of thrombocytopenia in determining neonatal outcomes. Thrombocytopenia is mostly common in hypothermic preterm babies because of the increased risk of sepsis, necrotizing enterocolitis, and slowing down of coagulation enzymes, disordered fibrinolysis, and disruption of platelet function [ 4 , 19 , 24 ]. Moreover, in our setting, management of thrombocytopenic preterm infants is still deficient (gap in accessibility, appropriate storage, and proper administration of blood components), contributing to poor outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Basic information, neonatal characteristics, newborn care-related factors, general medical condition, and the mother's delivery summary were all retrieved and collected from hospital records of preterm babies. The data extraction form was prepared based on the Federal Ministry of Health NICU management protocol [ 3 ], thermal protection WHO practical guide [ 4 ], and other peer-reviewed articles [ 8 , 12 , 19 – 21 ]. Five BSc (Bachelor of Science) neonatal nurses and two MSc (Masters of Science) holders were recruited for data collection and supervision, respectively.…”

Section: Methodsmentioning

confidence: 99%

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

Getaneh

¹

,

Misganaw

²

,

Mihretie

³

et al. 2022

International Journal of Pediatrics

2

0

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Background. Limited knowledge on the proportion of admission hypothermia and factors of death in hypothermic preterm neonates is hindering early and appropriate interventions in Ethiopia. Thus, studies on the proportion of admission hypothermia and factors of death in hypothermic preterm neonates are critical to enhancing preterm infants’ survival. Methods. Hospital-based cross-sectional study was conducted on 398 participants using the systematic sampling method from October 10, 2021, to December 15, 2022. A pretested data extraction tool was used to collect data. EpiData version 4.6 and STATA version 16 were used for data entry and analysis. Multivariable logistic regression analysis evaluated the association between independent and outcome variables with a 95% confidence interval (CI). Hosmer and Lemeshow test and variance inflation factor were assessed to check model fitness and collinearity, respectively. P value < 0.05 was considered statistically significant. Result. Of the 398 admitted preterm neonates, 331(83.2%) had hypothermia at admission. Factors that were significantly associated with mortality included outborn babies [Adjusted hazard ratio AOR = 2.18 : 95 % CI (1.03-4.62)], GA less than 32 weeks [ AOR = 6.64 : 95 % CI (1.87-13.58)], weight less than 1500 gram [ AOR = 7.91 : 95 % CI (1.21-15.38)], thrombocytopenia [ AOR = 3.36 : 95 % CI (1.49-7.58)], and kangaroo mother care [ AOR = 0.38 : 95 % CI (0.16-0.88)]. Conclusion. The proportion of admission hypothermia was high. Outborn babies, birth weight less than 1500 gram, gestational age < 32 weeks, being thrombocytopenic, and lack of kangaroo mother care were identified as risk factors for hypothermic preterm neonatal mortality. Preterm labor prevention, improved inborn delivery, and kangaroo mother care may alleviate the high proportion of admission hypothermia and related mortalities in preterm neonates.

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“…Temperature is an outcome that increases the risk of morbidity and mortality in this population. Mohamed et al [ 9 ] found the hypothermia is associated with mortality (OR = 1.89; 1.72–2.09), intra-ventricular hemorrhage (OR = 1.86; 1.09–3.14), bronchopulmonary dysplasia (OR = 1.28; 1.16–1.40) or neonatal sepsis (OR = 1.47; 1.09–2.49), and retinopathy of prematurity (OR = 1.45; 1.28–1.72). Similar results were found in other studies [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Lateral Kangaroo Care in Hemodynamic Stability of Extremely Preterm Infants: Protocol Study for a Non-Inferiority Randomized Controlled Trial CANGULAT

Collados-Gómez

¹

,

Esteban‐Gonzalo

²

,

López-López

³

et al. 2021

IJERPH

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Introduction: This study aims to assess the efficacy of the modified kangaroo care lateral position on the thermal stability of preterm neonates versus conventional kangaroo care prone position. Material and methods: A non-inferiority randomized parallel clinical trial. Kangaroo care will be performed in a lateral position for the experimental group and in a prone position for the control group preterm. The study will take place at the neonatal intensive care unit (NICU) of a University Hospital. The participants will be extremely premature infants (under 28 weeks of gestational age) along the first five days of life, hemodynamically stable, with mother or father willing to do kangaroo care and give their written consent to participate in the study. The sample size calculated was 35 participants in each group. When the premature infant is hemodynamically stable and one of the parents stays in the NICU, the patient will be randomized into two groups: an experimental group or a control group. The primary outcome is premature infant axillary temperature. Neonatal pain level and intraventricular hemorrhage are secondary outcomes. Discussion: There is no scientific evidence on modified kangaroo care lateral position. Furthermore, there is little evidence of increased intraventricular hemorrhage association with the lateral head position necessary in conventional or prone kangaroo care in extremely premature newborns. Kangaroo care is a priority intervention in neonatal units increasing the time of use more and more, making postural changes necessary to optimize comfort and minimize risks with kangaroo care lateral position as an alternative to conventional prone position kangaroo care. Meanwhile, it is essential to ensure that the conventional kangaroo care prone position, which requires the head to lay sideways, is a safe position in terms of preventing intraventricular hemorrhage in the first five days of life of children under 28 weeks of gestational age. Trial registration at clinicaltrials.gov: NCT03990116.

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Outcomes of neonatal hypothermia among very low birth weight infants: a Meta-analysis

Cited by 13 publications

References 42 publications

The prevalence for the risk of serious infection in hypothermic infants ≤ 60 days: A systematic review

The prevalence for the risk of serious infection in hypothermic infants ≤ 60 days: A systematic review

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

Lateral Kangaroo Care in Hemodynamic Stability of Extremely Preterm Infants: Protocol Study for a Non-Inferiority Randomized Controlled Trial CANGULAT

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