Department of Neonatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China.
Department of Neonatology, Shenzhen Guangming District People's Hospital, Shenzhen, Guangdong, China.
PeerJ. 2024 Nov 1;12:e18425. doi: 10.7717/peerj.18425. eCollection 2024.
Numerous studies have demonstrated that hypothermia in preterm infants correlates with increased morbidity and mortality, especially among those with very low or extremely low birth weights (VLBW/ELBW). An increasing number of healthcare facilities are implementing quality improvement (QI) bundles to lower the incidence of hypothermia at birth in this vulnerable population. However, the effectiveness and safety of these interventions have yet to be fully assessed. A meta-analysis is necessary to evaluate the efficacy and safety of QI bundles in reducing hypothermia at birth among VLBW/ELBW infants.
We searched PubMed, Embase, the Cochrane Library and Web of Science through April 22nd, 2024. Study selection, data extraction, quality evaluation and risk bias assessment were performed independently by two investigators. Meta-analysis was performed using Review Manager 5.4.1.
A total of 18 studies were included for qualitative analysis and 12 for meta-analysis. For VLBW infants, meta-analysis revealed a reduction in hypothermia and an increase in hyperthermia following the introduction of QI bundles (mild hypothermia, OR 0.22, 95% CI [0.13-0.37]; moderate hypothermia, OR 0.18, 95% CI [0.15-0.22]; hyperthermia, OR 2.79, 95% CI [1.53-5.09]). For ELBW infants, meta-analysis showed a decrease in hypothermia but no increase in hyperthermia after implementing QI bundles (mild hypothermia, OR 0.46, 95% CI [0.26-0.81]; moderate hypothermia, OR 0.21, 95% CI [0.08-0.58]; hyperthermia, OR 1.10, 95% CI [0.22-5.43]).
QI bundles effectively reduce hypothermia in VLBW/ELBW infants, but they may also increase hyperthermia, especially in VLBW infants.
许多研究表明，早产儿低体温与发病率和死亡率增加有关，尤其是极低出生体重儿（VLBW/ELBW）。越来越多的医疗机构正在实施质量改进（QI）措施，以降低这一脆弱人群出生时低体温的发生率。然而，这些干预措施的有效性和安全性尚未得到充分评估。因此，有必要进行荟萃分析来评估 QI 措施在降低 VLBW/ELBW 婴儿出生时低体温方面的疗效和安全性。
我们检索了 PubMed、Embase、Cochrane 图书馆和 Web of Science，检索时间截至 2024 年 4 月 22 日。两名研究者独立进行研究选择、数据提取、质量评估和风险偏倚评估。使用 Review Manager 5.4.1 进行荟萃分析。
共纳入 18 项研究进行定性分析，12 项研究进行荟萃分析。对于 VLBW 婴儿，荟萃分析显示，QI 措施的实施减少了低体温，增加了高热（轻度低体温，OR 0.22，95%CI [0.13-0.37]；中度低体温，OR 0.18，95%CI [0.15-0.22]；高热，OR 2.79，95%CI [1.53-5.09]）。对于 ELBW 婴儿，荟萃分析显示，QI 措施的实施降低了低体温，但没有增加高热（轻度低体温，OR 0.46，95%CI [0.26-0.81]；中度低体温，OR 0.21，95%CI [0.08-0.58]；高热，OR 1.10，95%CI [0.22-5.43]）。
QI 措施能有效降低 VLBW/ELBW 婴儿的低体温，但也可能增加高热，尤其是在 VLBW 婴儿中。
