Association Between Admission Temperature and Mortality and Major Morbidity in Preterm Infants Born at Fewer Than 33 Weeks’ Gestation

Lyu, Ying; Shah, Prakesh S.; Ye, Xiang Y.; Warre, Ruth; Piedboeuf, Bruno; Deshpandey, Akhil; Dunn, Michael; Lee, Shoo K.

doi:10.1001/jamapediatrics.2015.0277

Cited by 196 publications

(214 citation statements)

References 35 publications

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“…These include the EPICure study (infants <27 weeks’ gestation), 26 the California Perinatal Quality Care Collaborative (infants with a birth weight <1500 g), 27 the Brazilian Network of Neonatal Research (23–33 weeks), 28 and the Canadian Neonatal Network. 19 Consistent with these observations is a systematic review of prediction models for mortality among preterm infants. 29 Among 59 studies (1998–2010), 8 variables predicted survival, including a normal temperature on admission.…”

Section: Discussionmentioning

confidence: 79%

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Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants

Laptook

Bell

Shankaran

et al. 2018

The Journal of Pediatrics

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Objective To evaluate the temperature distribution among moderately preterm (MPT, 29–33 weeks) and extremely preterm (EPT, <29 weeks) infants upon neonatal intensive care unit (NICU) admission in 2012–2013, the change in admission temperature distribution for EPT infants between 2002–2003 and 2012–2013, and associations between admission temperature and mortality and morbidity for both MPT and EPT infants. Study design Prospectively collected data from 18 centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were used to examine NICU admission temperature of inborn MPT and EPT infants. Associations between admission temperature and mortality and morbidity were determined by multivariable logistic regression. EPT infants from 2002–2003 and 2012–2013 were compared. Results MPT and EPT cohorts consisted of 5818 and 3213 infants, respectively. The distribution of admission temperatures differed between the MPT vs EPT (P < .01), including the percentage <36.5°C (38.6% vs 40.9%), 36.5°C–37.5°C (57.3% vs 52.9%), and >37.5°C (4.2% vs 6.2%). For EPT infants in 2012–2013 compared with 2002–2003, the percentage of temperatures between 36.5°C and 37.5°C more than doubled and the percentage of temperatures >37.5°C more than tripled. Admission temperature was inversely associated with in-hospital mortality. Conclusions Low and high admission temperatures are more frequent among EPT than MPT infants. Compared with a decade earlier, fewer EPT infants experience low admission temperatures but more have elevated temperatures. In spite of a change in distribution of NICU admission temperature, an inverse association between temperature and mortality risk persists.

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Section: Discussionmentioning

confidence: 79%

“…The distribution of admission temperatures is similar to data reported by the Canadian Neonatal Network for 9833 infants born at <33 weeks gestation between 2010 and 2012. 19 …”

Section: Discussionmentioning

confidence: 99%

Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants

Laptook

Bell

Shankaran

et al. 2018

The Journal of Pediatrics

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“…We chose 36.5-37.5°C as the ideal range, in accordance with WHO guidelines [7]. In the study by Lyu et al [2], the admission temperature range of 36.5-37.2°C had the lowest rate of composite mortality and morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent literature review, the number of hypothermic preterms (<36.5°C) at admission was 36% [2]. In a large cohort of very preterm infants in Europe, more than half of the infants had a body temperature below 36.5°C at admission to the neonatal intensive care unit (NICU), and 13% of the infants had a body temperature under 35.5°C [3].…”

Section: Introductionmentioning

confidence: 99%

Temperature Probe Placement during Preterm Infant Resuscitation: A Randomised Trial

et al. 2017

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Background: Hypothermia on admission to intensive care is associated with poor outcomes in preterm infants. The neonatal resuscitation program recommends the use of servo-control thermoregulation during resuscitation. Very little evidence exists to guide optimal temperature probe placement in the delivery room. Objective: The aim of this work was to determine, in moderately preterm infants, if temperature probe placement in the dorsal, thoracic, or axillary area during delivery room resuscitation would result in differing temperatures on admission to the neonatal intensive care unit (NICU). Methods: A randomised trial with 3 arms was conducted. In total, 122 inborn preterm infants born between 28^0/7 and 35^6/7 weeks of gestational age were recruited. The infants were randomly assigned to thermal probe placement in the left lower back, left upper thorax, or left axilla immediately after birth. Temperature was servo-controlled using an infant resuscitation table set to 36.5°C. The primary outcome was axillary temperature at admission to the NICU before transfer to a closed isolette, recorded with a digital thermometer. The secondary outcomes assessed were temperature within the target range (36.5-37.5°C), hypothermia (<36.5°C), and hyperthermia (>37.5°C). Results: All 122 infants were available for outcome analysis. The groups were comparable for birthweight, gestational age, and sex. The mean admission temperature was comparable between the 3 probe positions (mean, 95% CI): dorsum (36.7°C, 36.6-36.8), thorax (36.8°C, 36.7-36.9), and axilla (36.7°C, 36.6-36.9), p = 0.43. The proportion of infants with admission temperatures in the target range was comparable (87.2, 81.4, and 72.5% respectively), p = 0.44. Conclusion: Dorsal, thoracic, or axillary temperature probe positioning during resuscitation yield similar admission temperatures in moderately preterm infants. Further studies are required in infants below 28 weeks of gestation to determine the best practice.

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“…Measures to diminish the severity of immediate postnatal heat loss have not eliminated the problem and 35 to 65% of premature newborns still experience hypothermia [2, 12-15]. The immediate application of occlusive wrap after birth has been shown to reduce postnatal evaporative heat loss [16].…”

mentioning

confidence: 99%

Parallel Exploratory RCT of Polyethylene Wrap for Heat Loss Prevention in Infants Born at Less than 24 Weeks’ Gestation

et al. 2019

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Background: The treatment effect of occlusive wrap applied immediately after delivery in infants born 24–28 weeks’ gestation has been studied, but the effect is not known in infants born at less than 24⁰/₇ weeks’ gestation. Objectives: To determine if the use of occlusive wrap applied immediately after birth in infants born at less than 24⁰/₇ weeks’ gestation results in any differences in outcomes when compared to non-wrapped infants. Methods: Parallel exploratory randomized controlled trial with a convenience sample of 28 inborn infants born at less than 24⁰/₇ weeks’ gestation enrolled during the duration of the HeLP trial. Infants were randomized to either the wrap or standard of care (no wrap) group. Results: Twenty-eight infants (wrap n = 14; no wrap n = 14) were randomized and data on all infants was available for intention-to-treat analysis. There were no differences in baseline population characteristics. There was no statistically significant difference in mortality (n = 8/14 wrap, 8/14 no wrap). There was no statistically significant difference in baseline temperature (35.9°C, SD = 1.12, wrap vs. 35.1°C, SD = 1.16, no wrap, p = 0.16) or post-stabilization temperature (36.4°C, SD = 0.84, wrap vs. 36.1°C, SD = 1.2, no wrap, p = 0.56). There was a trend towards increased baseline temperature in the wrap group. Conclusion: Application of occlusive wrap to infants born at less than 24⁰/₇ weeks’ gestation immediately after birth did not reduce mortality or effect baseline or post-stabilization temperature in this small exploratory study. This small sample provides the first estimate of treatment effect for this high-risk population.

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Association Between Admission Temperature and Mortality and Major Morbidity in Preterm Infants Born at Fewer Than 33 Weeks’ Gestation

Cited by 196 publications

References 35 publications

Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants

Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants

Temperature Probe Placement during Preterm Infant Resuscitation: A Randomised Trial

Parallel Exploratory RCT of Polyethylene Wrap for Heat Loss Prevention in Infants Born at Less than 24 Weeks’ Gestation

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