Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil.
Universidade Estadual de Campinas (UNICAMP), Centro de Atenção Integral à Saúde da Mulher (CAISM), Divisão de Neonatologia, Campinas, SP, Brazil.
J Pediatr (Rio J). 2018 Jul-Aug;94(4):368-373. doi: 10.1016/j.jped.2017.06.016. Epub 2017 Sep 6.
To evaluate the effectiveness of a thermoregulation bundle for preventing admission hypothermia in very low-birth weight preterm infants.
Interventional study with retrospective evaluation of data undertaken in a tertiary neonatal unit including all very low-birth weight preterm infants (<1500g) born at and admitted to the unit. Two periods were compared: before intervention (PI; 01/01/2012 to 02/28/2014_ and after intervention (PII; 04/01/2014 to 11/30/2016). The intervention started in March 2014. At PI procedures in the delivery room were: placement in a crib with a radiant heat source, doors always closed, polyethylene body plastic bag, double cap (plastic and cotton mesh), room temperature between 24 to 27°C and transport to neonatal unit in a pre-heated incubator (36-37.0°C). At PII, there was a reinforcement on not opening the plastic bag during the entire resuscitation process, even at an advanced stage, and the anthropometric measures and routine care were performed in the neonatal unit. Maternal, delivery, and neonatal variables were compared. Admission hypothermia was considered when admission axillary temperature was <36.0°C. Periodic results were shown to the team every six months and results were discussed.
The incidence of admission hypothermia was reduced significantly in PII (37.2 vs. 14.2%, p<0.0001) and admission temperature medians were higher (36.1 vs. 36.5°C, p<0.001). At PII, there was an increase in the number of infants transported with oxygen (49.5 vs. 75.5%, p<0.0001). No differences were observed regarding birth weight and gestational age.
There was a very important reduction in admission hypothermia incidence and a higher median admission temperature after continued protocol implementation.
评估体温调节护理包在预防极低出生体重早产儿入院低体温中的效果。
这是一项干预性研究，对三级新生儿病房的数据进行回顾性评估，包括所有在该病房出生和入院的极低出生体重早产儿（<1500g）。比较了两个时期：干预前（PI；2012 年 1 月 1 日至 2014 年 2 月 28 日）和干预后（PII；2014 年 4 月 1 日至 2016 年 11 月 30 日）。干预于 2014 年 3 月开始。PI 期间，产房内的操作包括：放置在带有辐射热源的婴儿床中，门始终关闭，使用聚乙烯体塑料袋，双层帽子（塑料和棉网），室温在 24 到 27°C 之间，并用预热的孵化器（36-37.0°C）将婴儿转移到新生儿病房。PII 期间，在整个复苏过程中，甚至在高级阶段，都不会打开塑料袋，新生儿的人体测量和常规护理都在新生儿病房进行。比较了产妇、分娩和新生儿的变量。入院时腋温<36.0°C 时，认为发生了入院低体温。每六个月向团队展示一次定期结果，并讨论结果。
PII 中入院低体温的发生率显著降低（37.2%比 14.2%，p<0.0001），入院时的体温中位数也更高（36.1°C 比 36.5°C，p<0.001）。PII 期间，需要输氧转运的婴儿数量增加（49.5%比 75.5%，p<0.0001）。出生体重和胎龄无差异。
持续实施该方案后，入院低体温的发生率显著降低，入院时体温中位数升高。
