Chang Hung-Yang, Sung Yi-Hsiang, Wang Shwu-Meei, Lung Hou-Ling, Chang Jui-Hsing, Hsu Chyong-Hsin, Jim Wai-Tim, Lee Ching-Hsiao, Hung Hsiao-Fang
Department of Pediatrics, MacKay Memorial Hospital, Hsinchu Branch, Hsinchu, Taiwan; Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan.
Department of Pediatrics, MacKay Memorial Hospital, Hsinchu Branch, Hsinchu, Taiwan.
PLoS One. 2015 Jul 20;10(7):e0131976. doi: 10.1371/journal.pone.0131976. eCollection 2015.
Neonatal hypothermia remains a common problem and is related to elevated morbidities and mortality. However, the long-term neurodevelopmental effects of admission hypothermia are still unknown. This study attempted to determine the short-term and long-term consequences of admission hypothermia in VLBW preterm infants.
This retrospective study measured the incidence and compared the outcomes of admission hypothermia in very low birth weight (VLBW) preterm infants in a tertiary-level neonatal intensive care unit. Infants were divided into the following groups: normothermia (36.5-37.5°C), mild hypothermia (36.0-36.4°C), moderate hypothermia (32.0-35.9°C), and severe hypothermia (< 32°C). We compared the distribution, demographic variables, short-term outcomes, and neurodevelopmental outcomes at 24 months of corrected age among groups.
We studied 341 infants: 79 with normothermia, 100 with mild hypothermia, 162 with moderate hypothermia, and 0 with severe hypothermia. Patients in the moderate hypothermia group had significantly lower gestational ages (28.1 wk vs. 29.7 wk, P < .02) and smaller birth weight (1004 g vs. 1187 g, P < .001) compared to patients in the normothermia group. Compared to normothermic infants, moderately hypothermic infants had significantly higher incidences of 1-min Apgar score < 7 (63.6% vs. 31.6%, P < .001), respiratory distress syndrome (RDS) (58.0% vs. 39.2%, P = .006), and mortality (18.5% vs. 5.1%, P = .005). Moderate hypothermia did not affect neurodevelopmental outcomes at 2 years' corrected age. Mild hypothermia had no effect on short-term or long-term outcomes.
Admission hypothermia was common in VLBW infants and correlated inversely with birth weight and gestational age. Although moderate hypothermia was associated with higher RDS and mortality rates, it may play a limited role among multifactorial causes of neurodevelopmental impairment.
新生儿低体温仍然是一个常见问题，且与发病率和死亡率升高有关。然而，入院时低体温对神经发育的长期影响仍不明确。本研究试图确定极低出生体重（VLBW）早产儿入院时低体温的短期和长期后果。
这项回顾性研究测量了三级新生儿重症监护病房中极低出生体重早产儿入院时低体温的发生率，并比较了其结局。婴儿被分为以下几组：正常体温（36.5 - 37.5°C）、轻度低体温（36.0 - 36.4°C）、中度低体温（32.0 - 35.9°C）和重度低体温（< 32°C）。我们比较了各组之间的分布、人口统计学变量、短期结局以及矫正年龄24个月时的神经发育结局。
我们研究了341例婴儿：79例体温正常，100例轻度低体温，162例中度低体温，0例重度低体温。与体温正常组的患者相比，中度低体温组的患者胎龄显著更低（28.1周对29.7周，P <.02），出生体重更小（1004克对1187克，P <.001）。与体温正常的婴儿相比，中度低体温的婴儿1分钟阿氏评分<7分的发生率显著更高（63.6%对31.6%，P <.001）、呼吸窘迫综合征（RDS）发生率更高（58.0%对39.2%，P =.006）以及死亡率更高（18.5%对5.1%，P =.005）。中度低体温在矫正年龄2岁时不影响神经发育结局。轻度低体温对短期或长期结局均无影响。
入院时低体温在极低出生体重婴儿中很常见，且与出生体重和胎龄呈负相关。尽管中度低体温与更高的呼吸窘迫综合征和死亡率相关，但在神经发育障碍的多因素病因中其作用可能有限。
