Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University, Palo Alto, California.
Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, California.
JAMA Netw Open. 2023 Aug 1;6(8):e2331011. doi: 10.1001/jamanetworkopen.2023.31011.
Thermoregulation is a key component of well-newborn care. There is limited epidemiologic data on hypothermia in late preterm and term infants admitted to the nursery. Expanding on these data is essential for advancing evidence-based care in a population that represents more than 3.5 million births per year in the US.
To examine the incidence and factors associated with hypothermia in otherwise healthy infants admitted to the newborn nursery following delivery.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study using electronic health record data from May 1, 2015, to August 31, 2021, was conducted at a newborn nursery at a university-affiliated children's hospital. Participants included 23 549 infants admitted to the newborn nursery, from which 321 060 axillary and rectal temperature values were analyzed.
Infant and maternal clinical and demographic factors.
Neonatal hypothermia was defined according to the World Health Organization threshold of temperature less than 36.5 °C. Hypothermia was further classified by severity (mild: single episode, temperature 36.0-36.4 °C; moderate/severe: persistent or recurrent hypothermia and/or temperature <36.0 °C) and timing (early: all hypothermic episodes occurred within the first 24 hours after birth; late: any episode extended beyond the first 24 hours).
Of 23 549 included infants (male, 12 220 [51.9%]), 5.6% were late preterm (35-36 weeks' gestation) and 4.3% were low birth weight (≤2500 g). The incidence of mild hypothermia was 17.1% and the incidence of moderate/severe hypothermia was 4.6%. Late hypothermia occurred in 1.8% of infants. Lower birth weight and gestational age and Black and Asian maternal race and ethnicity had the highest adjusted odds across all classifications of hypothermia. The adjusted odds ratios of moderate/severe hypothermia were 5.97 (95% CI 4.45-8.00) in infants with a birth weight less than or equal to 2500 vs 3001 to 3500 g, 3.17 (95% CI 2.24-4.49) in 35 week' vs 39 weeks' gestation, and 2.65 (95% CI 1.78-3.96) in infants born to Black mothers and 1.94 (95% CI 1.61-2.34) in infants born to Asian mothers vs non-Hispanic White mothers.
In this cohort study of infants in the inpatient nursery, hypothermia was common, and the incidence varied by hypothermia definition applied. Infants of lower gestational age and birth weight and those born to Black and Asian mothers carried the highest odds of hypothermia. These findings suggest that identifying biological, structural, and social determinants of hypothermia is essential for advancing evidence-based equitable thermoregulatory care.
体温调节是新生儿护理的重要组成部分。关于早产儿和足月婴儿在进入新生儿病房后出现低体温的流行病学数据有限。为了在每年代表超过 350 万例出生的人群中推进基于证据的护理，扩大这些数据非常重要。
研究在分娩后进入新生儿病房的健康婴儿中低体温的发生率和相关因素。
设计、设置和参与者：这是一项回顾性队列研究，使用 2015 年 5 月 1 日至 2021 年 8 月 31 日期间来自一所大学附属儿童医院新生儿病房的电子健康记录数据。参与者包括 23549 名进入新生儿病房的婴儿，从中分析了 321060 次腋温和直肠温度值。
婴儿和产妇的临床和人口统计学因素。
根据世界卫生组织的阈值，将新生儿低体温定义为体温低于 36.5°C。低体温进一步按严重程度（轻度：单次发作，体温 36.0-36.4°C；中度/重度：持续或反复出现低体温和/或体温<36.0°C）和时间（早期：所有低体温发作均发生在出生后 24 小时内；晚期：任何发作均延长至 24 小时后）进行分类。
在 23549 名纳入的婴儿中（男性 12220 [51.9%]），5.6%为晚期早产儿（35-36 周），4.3%为低出生体重（≤2500g）。轻度低体温的发生率为 17.1%，中度/重度低体温的发生率为 4.6%。1.8%的婴儿出现晚期低体温。所有低体温分类中，较低的出生体重和胎龄以及黑人和亚洲产妇的种族和民族具有最高的调整后比值比。出生体重≤2500g与 3001-3500g的婴儿中度/重度低体温的调整后比值比为 5.97（95%CI 4.45-8.00），35 周与 39 周胎龄的婴儿为 3.17（95%CI 2.24-4.49），黑人母亲的婴儿为 2.65（95%CI 1.78-3.96），而亚洲母亲的婴儿为 1.94（95%CI 1.61-2.34）非西班牙裔白人母亲的婴儿。
在这项对住院婴儿的队列研究中，低体温很常见，且其发生率因应用的低体温定义而异。胎龄和出生体重较低的婴儿以及黑人和亚洲母亲所生的婴儿出现低体温的几率最高。这些发现表明，确定低体温的生物学、结构和社会决定因素对于推进基于证据的公平体温调节护理至关重要。
