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J Pediatr. 2014 Feb;164(2):271-5.e1. doi: 10.1016/j.jpeds.2013.09.049. Epub 2013 Nov 6.

Hypothermia and early neonatal mortality in preterm infants.

Author information

1
Division of Neonatal Medicine, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil.
2
Division of Neonatal Medicine, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil. Electronic address: ruthgbr@netpoint.com.br.
3
Department of Pediatrics, Universidade Estadual de Campinas/Hospital da Mulher Prof. Dr. José Aristodemo Pinotti, Campinas, SP, Brazil.
4
Department of Public Health, Universidade Federal do Maranhão/Hospital Universitário, São Luís, MA, Brazil.
5
Department of Pediatrics, Universidade de São Paulo/Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, SP, Brazil.
6
Department of Pediatrics, Universidade Federal do Paraná/Hospital de Clínicas, Curitiba, PR, Brazil.
7
Department of Pediatrics and Pediatric Surgery, Universidade Estadual de Londrina/Hospital Universitário, Londrina, PR, Brazil.
8
Department of Pediatrics, Faculdade de Medicina de Botucatu da Universidade Estadual Paulista, Botucatu, SP, Brazil.
9
Department of Pediatrics, Universidade Federal de Uberlândia/Hospital de Clínicas, Uberlândia, MG, Brazil.
10
Department of Pediatrics, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.

Abstract

OBJECTIVE:

To evaluate intervention practices associated with hypothermia at both 5 minutes after birth and at neonatal intensive care unit (NICU) admission and to determine whether hypothermia at NICU admission is associated with early neonatal death in preterm infants.

STUDY DESIGN:

This prospective cohort included 1764 inborn neonates of 22-33 weeks without malformations admitted to 9 university NICUs from August 2010 through April 2012. All centers followed neonatal International Liaison Committee on Resuscitation recommendations for the stabilization and resuscitation in the delivery room (DR). Variables associated with hypothermia (axillary temperature <36.0 °C) 5 minutes after birth and at NICU admission, as well as those associated with early death, were analyzed by logistic regression.

RESULTS:

Hypothermia 5 minutes after birth and at NICU admission was noted in 44% and 51%, respectively, with 6% of early neonatal deaths. Adjusted for confounding variables, practices associated with hypothermia at 5 minutes after birth were DR temperature <25 °C (OR 2.13, 95% CI 1.67-2.28), maternal temperature at delivery <36.0 °C (OR 1.93, 95% CI 1.49-2.51), and use of plastic bag/wrap (OR 0.53, 95% CI 0.40-0.70). The variables associated with hypothermia at NICU admission were DR temperature <25 °C (OR 1.44, 95% CI 1.10-1.88), respiratory support with cold air in the DR (OR 1.40, 95% CI 1.03-1.88) and during transport to NICU (OR 1.51, 95% CI 1.08-2.13), and cap use (OR 0.55, 95% CI 0.39-0.78). Hypothermia at NICU admission increased the chance of early neonatal death by 1.64-fold (95% CI 1.03-2.61).

CONCLUSION:

Simple interventions, such as maintaining DR temperature >25 °C, reducing maternal hypothermia prior to delivery, providing plastic bags/wraps and caps for the newly born infants, and using warm resuscitation gases, may decrease hypothermia at NICU admission and improve early neonatal survival.

KEYWORDS:

DR; Delivery room; NICU; Neonatal intensive care unit; VLBW; Very low birth weight

PMID:
24210925
DOI:
10.1016/j.jpeds.2013.09.049
[Indexed for MEDLINE]

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