Department of Pediatrics, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, Brazil.
, Campinas, Brazil.
Eur J Pediatr. 2019 Jul;178(7):1023-1032. doi: 10.1007/s00431-019-03386-9. Epub 2019 May 6.
This prospective cohort study aimed to assess the association of admission hypothermia (AH) with death and/or major neonatal morbidities among very low birth weight (VLBW) preterm infants based on the relative performance of 20 centers of the Brazilian Network of Neonatal Research. This is a retrospective analysis of prospectively collected data using the database registry of the Brazilian Network on Neonatal Research. Center performance was defined by the relative mortality rate using conditional inference trees. A total of 4356 inborn singleton VLBW preterm infants born between January 2013 and December 2016 without malformations were included in this study. The centers were divided into two groups: G1 (with lower mortality rate) and G2 (with higher mortality rate). Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were estimated by simple and multiple log-binomial regression models. An AH rate of 53.7% (19.8-93.3%) was significantly associated with early neonatal death in G1 (adjusted RR 1.41, 95% CI 1.09-1.84) and G2 (adjusted RR 1.29, 95%CI 1.01-1.65) and with in-hospital death in G1 (adjusted RR 1.29, 95%CI 1.07-1.58). AH was significantly associated with a lower frequency of necrotizing enterocolitis (adjusted RR 0.58, 95%CI 38-0.88) in G2.Conclusion: AH significantly associated with early neonatal death regardless of the hospital performance. In G2, an unexpected protective association between AH and necrotizing enterocolitis was found, whereas the other morbidities assessed were not significantly associated with AH. What is Known: • Admission hypothermia is associated with early neonatal death. • The association of admission hypothermia with major neonatal morbidities has not been fully established. What is New: • Admission hypothermia was significantly associated with early neonatal and in-hospital death in centers with the lowest relative mortality rates. • Admission hypothermia was not associated with major neonatal morbidities and with in-hospital death but was found to be a protective factor against necrotizing colitis in centers with the highest relative mortality rates.
这项前瞻性队列研究旨在评估基于巴西新生儿研究网络 20 个中心的相对表现，入院低体温（AH）与极低出生体重（VLBW）早产儿死亡和/或主要新生儿并发症的相关性。这是对巴西新生儿研究网络前瞻性收集数据的数据库登记进行的回顾性分析。中心表现通过条件推理树定义为相对死亡率。本研究共纳入 2013 年 1 月至 2016 年 12 月期间无畸形的 4356 名宫内单胎 VLBW 早产儿。这些中心被分为两组：G1（死亡率较低）和 G2（死亡率较高）。使用简单和多对数二项式回归模型估计了粗和调整后的相对风险（RR）和 95%置信区间（95%CI）。G1（调整 RR 1.41，95%CI 1.09-1.84）和 G2（调整 RR 1.29，95%CI 1.01-1.65）中早期新生儿死亡和 G1（调整 RR 1.29，95%CI 1.07-1.58）中院内死亡与 AH 发生率为 53.7%（19.8-93.3%）显著相关。AH 与坏死性小肠结肠炎的发生频率较低显著相关（G2 调整 RR 0.58，95%CI 38-0.88）。结论：AH 与早期新生儿死亡显著相关，与医院表现无关。在 G2 中，发现 AH 与坏死性小肠结肠炎之间存在意外的保护关联，而评估的其他并发症与 AH 无显著关联。已知的：• 入院低体温与早期新生儿死亡有关。• 入院低体温与主要新生儿并发症的相关性尚未完全确定。新的：• 入院低体温与死亡率最低的中心的早期新生儿和院内死亡显著相关。• 入院低体温与主要新生儿并发症和院内死亡无关，但在死亡率最高的中心发现其是坏死性结肠炎的保护因素。
