Mathur N B, Krishnamurthy Sriram, Mishra T K
Department of Pediatrics, Maulana Azad Medical College, New Delhi, India.
J Trop Pediatr. 2005 Dec;51(6):341-5. doi: 10.1093/tropej/fmi049. Epub 2005 Jul 13.
The objective of this study is to correlate the severity of hypothermia in sick extramural neonates with fatality and physiological derangements. This is a prospective observational study carried out at the referral neonatal unit of a teaching hospital admitting extramural neonates. The subjects comprised of 100 extramural hypothermic neonates transported to the Referral neonatal unit. Neonates weighing more than 1000 g, with abdominal skin temperature less than 36.5 degrees C at admission were included in the study. Hypothermia was classified as per WHO recommendations. Clinical features including age, weight, gestational age, clinical diagnosis, vitals, place of delivery, details of transportation and capillary filling time were recorded at the time of admission. Oxygen saturation was recorded by a pulse oximeter. Samples for sepsis screen, blood culture and blood glucose were taken at admission. During the study it was observed that fatality was 39.3% in mildly hypothermic babies, 51.6% in moderately hypothermic babies and 80% in severely hypothermic babies. However, the presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g were associated with more than 50% fatality even in mildly hypothermic babies. When moderate hypothermia was associated with hypoxia or shock, the fatality was 83.3% and 90.9% respectively. Similarly, mild hypothermia with hypoglycemia was associated with 71.4% fatality. The conclusion drawn from this study is that the WHO classification of severity of hypothermia correlates with the risk of fatality. However, it considers only body temperature to classify severity of hypothermia. The presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g should be considered adverse factors in hypothermic neonates. Their presence should classify hypothermia in the next higher category of severity in WHO classification.
本研究的目的是将院外患病新生儿体温过低的严重程度与死亡率及生理紊乱相关联。这是一项在前瞻性观察研究，在一家收治院外新生儿的教学医院的转诊新生儿病房进行。研究对象包括100名转运至转诊新生儿病房的院外体温过低的新生儿。纳入研究的新生儿体重超过1000克，入院时腹部皮肤温度低于36.5摄氏度。体温过低按照世界卫生组织的建议进行分类。入院时记录临床特征，包括年龄、体重、胎龄、临床诊断、生命体征、分娩地点、转运细节和毛细血管充盈时间。通过脉搏血氧仪记录血氧饱和度。入院时采集用于败血症筛查、血培养和血糖检测的样本。在研究过程中观察到，轻度体温过低的婴儿死亡率为39.3%，中度体温过低的婴儿为51.6%，重度体温过低的婴儿为80%。然而，即使在轻度体温过低的婴儿中，存在相关疾病（出生窒息、新生儿败血症和呼吸窘迫）、生理紊乱（缺氧、低血糖和休克）以及体重低于2000克与超过50%的死亡率相关。当中度体温过低与缺氧或休克相关时，死亡率分别为83.3%和90.9%。同样，轻度体温过低合并低血糖的死亡率为71.4%。本研究得出的结论是，世界卫生组织对体温过低严重程度的分类与死亡风险相关。然而，它仅根据体温来分类体温过低的严重程度。存在相关疾病（出生窒息、新生儿败血症和呼吸窘迫）、生理紊乱（缺氧、低血糖和休克）以及体重低于2000克应被视为体温过低新生儿的不利因素。它们的存在应将体温过低在世卫组织分类中归为更高一级的严重程度类别。
