Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, Canada.
Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario, Canada.
BMC Pediatr. 2022 Jul 25;22(1):447. doi: 10.1186/s12887-022-03512-x.
Lack of appropriate temperature management has been associated with significant adverse outcomes in preterm and low birthweight neonates. There is a lack of similar investigations in the late preterm (34-36) and term (≥37) neonate population. Our aim was to identify key risk factors as well as clinical outcomes associated with hypothermia in this population.
A retrospective chart review was conducted at the Ottawa Hospital including all eligible infants ≥34 weeks' gestation over a one-month period in November 2020. Infant, maternal, and delivery room variables were collected, including prematurity, maternal temperature, delivery mode, birthweight, and premature rupture of membranes, as well as clinical outcomes such as NICU/SCN admission and length of stay. Regression models were generated, adjusted for covariates, and stepwise regression was performed.
Four hundred forty infants were included in the analysis; 26.8% (118/440) were hypothermic within 6 hours of delivery. In the multivariable analysis, prematurity, low 5 minute Apgar score (< 7) or need for resuscitation, maternal hypertension, and absence of premature rupture of membranes > 18 hours or suspected maternal infection were significantly associated with hypothermia within 6 hours of delivery (p < 0.05). Multivariable analysis of clinical outcomes demonstrated a significant association between hypothermia within 6 hours of delivery and NICU/SCN admission (OR = 2.87; 95% CI 1.36, 6.04), need for respiratory support or diagnosis of respiratory distress syndrome (OR = 3.94; 95% CI 1.55, 10.50), and length of stay (exp(β) = 1.20; 95% bootstrap CI 1.04, 1.37).
Our results suggest there are similar factors associated with hypothermia in our study population of infants born at ≥34 weeks' gestation compared to prior studies in preterm and low-birthweight infants. Furthermore, hypothermia is associated with higher risk of adverse outcomes, which highlights the need to prevent hypothermia in all newborns.
早产儿和低出生体重儿在体温管理不当的情况下会出现严重的不良后果。在晚期早产儿（34-36 周）和足月（≥37 周）新生儿中，缺乏类似的调查。我们的目的是确定该人群中与低体温相关的关键危险因素和临床结局。
我们对渥太华医院 2020 年 11 月的一个月内所有≥34 周的合格婴儿进行了回顾性图表审查。收集了婴儿、产妇和产房变量，包括早产、产妇体温、分娩方式、出生体重和胎膜早破，以及新生儿重症监护病房/特殊护理病房入院和住院时间等临床结局。生成回归模型，调整协变量，并进行逐步回归。
440 名婴儿纳入分析；6 小时内有 26.8%（118/440）体温过低。多变量分析显示，早产、5 分钟 Apgar 评分低（<7）或需要复苏、产妇高血压、胎膜早破>18 小时或疑似产妇感染与 6 小时内低体温显著相关（p<0.05）。6 小时内低体温与新生儿重症监护病房/特殊护理病房入院（比值比=2.87；95%置信区间 1.36-6.04）、需要呼吸支持或诊断呼吸窘迫综合征（比值比=3.94；95%置信区间 1.55-10.50）和住院时间（EXP（β）=1.20；95%bootstrap 置信区间 1.04-1.37）之间存在显著关联。
我们的研究结果表明，与早产和低出生体重儿的先前研究相比，≥34 周出生的婴儿中，导致低体温的因素相似。此外，低体温与不良结局风险增加相关，这强调了所有新生儿都需要预防低体温。
