Elsevier

The Journal of Pediatrics

Volume 164, Issue 2, February 2014, Pages 271-275.e1
The Journal of Pediatrics

Original Article
Hypothermia and Early Neonatal Mortality in Preterm Infants

https://doi.org/10.1016/j.jpeds.2013.09.049Get rights and content

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.

Section snippets

Methods

We conducted a multicenter prospective cohort study of infants born at gestational ages of 230/7 to 336/7 weeks without congenital anomalies and admitted at 9 centers of the Brazilian Network on Neonatal Research between August 2010 and April 2012. All of the centers are level III public university hospitals and serve as referral centers for high-risk pregnancies. All of the hospitals have NICU beds and the staff, equipment, and infrastructure required to treat critically ill neonates. The

Results

During the study period, 1955 inborn preterm infants with gestational ages of 23-33 weeks and without congenital anomalies satisfied our inclusion criteria, and 1764 (90%) were enrolled in the study. Enrollment varied from 115 to 262 neonates per center. Axillary temperature at 5 minutes after birth was measured in 1374 neonates, and hypothermia was noted in 44% (median 36.0°C; 25th-75th percentiles 35.5°C-36.4°C). Axillary temperature at NICU admission was measured in 1764 neonates at an

Discussion

In this cohort of inborn preterm infants born at 23-33 weeks of gestational age, the incidence of hypothermia 5 minutes after birth was extremely high and was independently associated with low DR temperature, maternal hypertension, maternal hypothermia, lower gestational age, and lack of plastic bag/wrap. The presence of hypothermia soon after birth was the main contributor to hypothermia at NICU admission, which increased the chance of early neonatal death by 64%. These results add to the

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Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (472827-2009-0). The authors declare no conflicts of interest.

List of members of the Brazilian Network on Neonatal Research is available at www.jpeds.com (Appendix).

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