BMC Pediatrics (Jun 2020)

Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study

  • Yong-hui Yu,
  • Li Wang,
  • Lei Huang,
  • Li-ling Wang,
  • Xiao-yang Huang,
  • Xiu-fang Fan,
  • Yan-jie Ding,
  • Cheng-yuan Zhang,
  • Qiang Liu,
  • Ai-rong Sun,
  • Yue-hua Zhao,
  • Guo Yao,
  • Cong Li,
  • Xiu-xiang Liu,
  • Jing-cai Wu,
  • Zhen-ying Yang,
  • Tong Chen,
  • Xue-yun Ren,
  • Jing Li,
  • Mei-rong Bi,
  • Fu-dong Peng,
  • Min Geng,
  • Bing-ping Qiu,
  • Ri-ming Zhao,
  • Shi-ping Niu,
  • Ren-xia Zhu,
  • Yao Chen,
  • Yan-ling Gao,
  • Li-ping Deng

DOI
https://doi.org/10.1186/s12887-020-02221-7
Journal volume & issue
Vol. 20, no. 1
pp. 1 – 9

Abstract

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Abstract Background The objective of this prospective, multicentre, observational cohort study was to evaluate the association between admission hypothermia and neonatal outcomes in very low-birth weight (VLBW) infants in multiple neonatal intensive care units (NICUs) in China. Methods Since January 1, 2018, a neonatal homogeneous cooperative research platform-Shandong Neonatal Network (SNN) has been established. The platform collects clinical data in a prospective manner on preterm infants with birth weights (BWs) < 1500 g and gestational ages (GAs) < 34 weeks born in 28 NICUs in Shandong Province. These infants were divided into normothermia, mild or moderate/severe hypothermia groups according to the World Health Organization (WHO) classifications of hypothermia. Associations between outcomes and hypothermia were tested in a bivariate analysis, followed by a logistic regression analysis. Results A total of 1247 VLBW infants were included in this analysis, of which 1100 infants (88.2%) were included in the hypothermia group, 554 infants (44.4%) in the mild hypothermia group and 546 infants (43.8%) in the moderate/severe hypothermia group. Small for gestational age (SGA), caesarean section, a low Apgar score at 5 min and intubation in the delivery room (DR) were related to admission hypothermia (AH). Mortality was the lowest when their admission temperature was 36.5 ~ 37.5 °C, and after adjustment for maternal and infant characteristics, mortality was significantly associated with AH. Compared with infants with normothermia (36.5 ~ 37.5 °C), the adjusted ORs of all deaths increased to 4.148 (95% CI 1.505–11.437) and 1.806 (95% CI 0.651–5.009) for infants with moderate/severe hypothermia and mild hypothermia, respectively. AH was also associated with a high likelihood of respiratory distress syndrome (RDS), intraventricular haemorrhage (IVH), and late-onset neonatal sepsis (LOS). Conclusions AH is still very high in VLBW infants in NICUs in China. SGA, caesarean section, a low Apgar score at 5 min and intubation in the DR were associated with increased odds of hypothermia. Moderate/severe hypothermia was associated with mortality and poor outcomes, such as RDS, IVH, LOS.

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