Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi.
Department of Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi.
J Trop Pediatr. 2020 Oct 1;66(5):470-478. doi: 10.1093/tropej/fmz086.
To evaluate associations with neonatal hypothermia in a tertiary-level neonatal unit (NU) in Malawi.
Neonates with a birth weight >1000 g were recruited and temperatures were recorded 5 min after birth, on admission and 4 h thereafter. Clinical course and outcome were reviewed. Data were analysed using Stata v.15 and p < 0.05 was considered statistically significant.
Between August 2018 to March 2019, 120 neonates were enrolled, and 112 were included in the data analysis. Hypothermia at 5 min after birth was noted in 74%, 77% on admission to the NU and 38% at 24 h. Neonates who had hypothermia 5 min after birth were more likely to have hypothermia on admission to the NU compared with normothermic subjects (p < 0.01). All neonates with hypothermia on admission to the NU died (100 vs.72%, p = 0.02), but hypothermia at 5 min nor at 24 h were not associated with mortality. After adjusting for potential confounders, the odds ratio of hypothermia at 5 min for hypothermia on admission to NU was 13.31 (95% CI 4.17-42.54).
A large proportion of hospitalized neonates is hypothermic on admission and has associated morbidity and mortality. Our findings suggest that a strong predictor of mortality is neonatal hypothermia on admission to the NU, and that early intervention in the immediate period after delivery could decrease the incidence of hypothermia and reduce associated morbidity and mortality.
评估马拉维三级新生儿单位（NU）中新生儿低体温的相关因素。
招募出生体重>1000g 的新生儿，在出生后 5 分钟、入院时和入院后 4 小时记录体温。回顾临床过程和结局。使用 Stata v.15 进行数据分析，p<0.05 被认为具有统计学意义。
2018 年 8 月至 2019 年 3 月期间，共纳入 120 名新生儿，其中 112 名纳入数据分析。出生后 5 分钟时低体温的发生率为 74%，入院时为 77%，24 小时时为 38%。与正常体温的新生儿相比，出生后 5 分钟时低体温的新生儿更有可能在入院时发生低体温（p<0.01）。所有入院时低体温的新生儿均死亡（100% vs.72%，p=0.02），但入院时和 24 小时时的低体温均与死亡率无关。在校正潜在混杂因素后，出生后 5 分钟时低体温对入院时低体温的优势比为 13.31（95%CI 4.17-42.54）。
大量住院新生儿入院时体温过低，与发病率和死亡率相关。我们的研究结果表明，入院时新生儿低体温是死亡率的一个重要预测因素，在分娩后立即采取早期干预措施可能会降低低体温的发生率，减少相关发病率和死亡率。
