Laptook Abbot R, Salhab Walid, Bhaskar Brinda
Department of Pediatrics, Brown Medical School, Brown University, Providence, Rhode Island, USA.
Pediatrics. 2007 Mar;119(3):e643-9. doi: 10.1542/peds.2006-0943. Epub 2007 Feb 12.
There is a paucity of information on the maintenance of body temperature at birth for low birth weight infants.
We examined the distribution of temperatures in low birth weight infants on admission to the NICUs in the Neonatal Research Network centers and determined whether admission temperature was associated with antepartum and birth variables and selected morbidities and mortality.
Infants without major congenital anomalies born during 2002 and 2003 with birth weights of 401 to 1499 g who were admitted directly from the delivery room to the NICU were included. Bivariate associations between antepartum/birth variables and admission temperature and selected morbidities/mortality and admission temperature were examined, followed by multivariable linear or logistic regressions to detect independent associations.
There were 5277 study infants and the mean (+/-SD) birth weight and gestational age were 1036 +/- 286 g and 28 +/- 3 weeks, respectively. The distribution of admission temperatures was 14.3% at < 35 degrees C, 32.6% between 35 and 35.9 degrees C, 42.3% between 36 and 36.9 degrees C, and 10.8% at > or = 37 degrees C. The estimate of birth weight on admission temperature with and without intubation was +0.13 degrees C and +0.04 degrees C per 100-g increase in birth weight, respectively. The mean admission temperature for each center varied from 1.5 degrees C below to 0.3 degrees C above a reference center. On adjusted analyses, admission temperature was inversely related to mortality (28% increase per 1 degrees C decrease) and late-onset sepsis (11% increase per 1 degrees C decrease) but not to intraventricular hemorrhage, necrotizing enterocolitis, or duration of conventional ventilation.
Preventing decreases in temperature at birth among low birth weight infants remains a challenge. Associations with intubation and center of birth suggest that assessment of temperature control for infants intubated in the delivery room may be beneficial. Whether the admission temperature is part of the casual path or a marker of mortality needs additional study.
关于低出生体重儿出生时体温维持情况的信息匮乏。
我们研究了新生儿研究网络中心新生儿重症监护病房（NICU）收治的低出生体重儿入院时的体温分布情况，并确定入院体温是否与产前及出生相关变量、特定疾病及死亡率有关。
纳入2002年至2003年出生、出生体重在401至1499克、无重大先天性异常且从产房直接收治入NICU的婴儿。研究产前/出生变量与入院体温之间以及特定疾病/死亡率与入院体温之间的双变量关联，随后进行多变量线性或逻辑回归以检测独立关联。
共有5277名研究婴儿，平均（±标准差）出生体重和胎龄分别为1036±286克和28±3周。入院体温分布情况为：<35℃时占14.3%，35至35.9℃之间占32.6%，36至36.9℃之间占42.3%，≥37℃时占10.8%。插管和未插管情况下，出生体重每增加100克，入院体温估计分别升高0.13℃和0.04℃。各中心的平均入院体温比一个参考中心低1.5℃至高0.3℃。经校正分析，入院体温与死亡率（每降低1℃增加28%）和晚发性败血症（每降低1℃增加11%）呈负相关，但与脑室内出血、坏死性小肠结肠炎或传统通气时间无关。
防止低出生体重儿出生时体温下降仍是一项挑战。与插管及出生中心的关联表明，评估产房内插管婴儿的体温控制可能有益。入院体温是因果路径的一部分还是死亡率的一个标志物，需要进一步研究。
