Hypothermia and neonatal morbimortality in very low birth weight preterm infants

Cordeiro, Rafaelle Cristine Oliveira; Ferreira, Daniela Marques de Lima Mota; Reis, Heloísio dos; Azevedo, Vivian Mara Gonçalves de Oliveira; Protázio, Airan dos Santos; Abdallah, Vânia Olivetti Steffen

doi:10.1590/1984-0462/2022/40/2020349

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Revista Paulista de Pediatria

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Original Article • Rev. paul. pediatr. 40 • 2022 • https://doi.org/10.1590/1984-0462/2022/40/2020349 copy

Hypothermia and neonatal morbimortality in very low birth weight preterm infants

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To assess the prevalence of hypothermia in the delivery room, at admission, and 2 to 3 hours after admission in the neonatal intensive care unit (NICU), factors associated and possible relationship with morbidity and mortality in preterm infants with very low birth weight (VLBW).

Methods:

Cross-sectional study with data collection based on a retrospective review of medical records and including infants born in 2016 and 2017, with birth weights <1500g, and gestational ages <34 weeks. Data about VLBW preterm infants, maternal data and temperature in the delivery room were analyzed. Hypothermia was considered when axillary temperature <36°C. For statistical analysis, the chi-square test or G test, canonical and Spearman correlation, and logistic regression were used.

Results:

149 newborns (NB) were included in the study. The prevalence of hypothermia in delivery room, at admission to the NICU and 2 to 3 hours after admission was 25.8%, 41.5% and 40.2%, respectively. The temperature of NBs was directly proportional to gestational age (p<0.010), birth weight (p<0.010), and Apgar score (p<0.050). There was an inverse association with hypothermia in the delivery room and cesarean delivery (OR 0.25; p=0.016).

Conclusions:

Hypothermia was a prevalent problem in the studied population. The neonatal temperature was directly proportional to gestational age, birth weight and Apgar score. Hypothermia was associated with maternal factors, such as cesarean delivery. It is necessary to implement and improve strategies for its prevention.

Keywords:
Hypothermia; Infant, very low birth weight; Indicators of morbidity and mortality; Quality of health care

	NB's temperature in the delivery room			NB's temperature upon admission to NICU			NB temperature 2–3 hours after admission to NICU
	T≥36°C	T<36°C	p-value	T≥36°C	T<36°C	p-value	T≥36°C	T<36°C	p-value
Gestational age (weeks)^* * described as mean ± standard deviation.	28.5±2.1	26.4±2.4	<0.010^a a Canonical Correlation	28.5±2.3	26.9±2.6	<0.010^a a Canonical Correlation	28.5±2.3	26.8±2.5	<0.010^a a Canonical Correlation
Birth weight (grams)	1,029±267	821±252	<0.010^a a Canonical Correlation	1,060±253	831±255	<0.010^a a Canonical Correlation	1,064± 251	838±267	<0.010^a a Canonical Correlation
1st minute Apgar^* * described as mean ± standard deviation.	5.7±2.3	4.3±2.7	<0.050^a a Canonical Correlation	5.6±2.4	4.5±2.7	<0.050^a a Canonical Correlation	5.9±2.4	4.3±2.6	<0.050^a a Canonical Correlation
5th minute Apgar^* * described as mean ± standard deviation.	8.4±1.3	7.5±1.6	<0.050^a a Canonical Correlation	8.3±1.4	7.5±1.9	>0.050^a a Canonical Correlation	8.4±1.2	7.4±1.9	<0.010^a a Canonical Correlation

	Hypothermic NB — T<36°C		Non-hypothermic NB — T≥36°C		p-value
	Total^a a total newborns analyzed for each variable;	n (%)	Total^a a total newborns analyzed for each variable;	n (%)	p-value
Resuscitation at birth	61	45 (73.8)	86	62 (72.1)	0.854^b b chi-square test;
PIVH	57	32 (56.1)	85	33 (38.8)	0.042^b b chi-square test;
Late sepsis	57	34 (59.7)	82	29 (35.4)	0.004^b b chi-square test;
Necrotizing enterocolitis	60	3 (5.0)	88	9 (10.2)	0.239^c c test G.
BPD	36	23 (63.9)	74	35 (47.3)	0.102^b b chi-square test;
ROP	33	10 (30.3)	69	21 (30.4)	0.989^b b chi-square test;
Death	61	27 (44.3)	86	16 (18.6)	<0.001^b b chi-square test;

		Odds Ratio	95%CI	p-value	Odds Ratio	95%CI	p-value
		Initial model containing all variables			Final model containing only the variables selected in the Stepwise method
Hypothermia in VLBW PTNB in the delivery room
Mothers’ and delivery^a a multiple logistic regression;
	Peripartum hemorrhage	0.53	0.11 a 2.05	0.392	–	–	–
	Cesarean delivery	0.29	0.09 a 0.92	0.034	0.25	0.08 a 0.78	0.016
	Multiple gestation	0.41	0.12 a 1.23	0.129	–	–	–
	Maternal hypothermia	2.71	0.99 a 7.57	0.054	2.29	0.86 a 6.19	0.096
Hypothermia in VLBW PTNB upon admission to the NICU
Neonatal^b b logistic regression adjusted for gestational age and need for resuscitation.
	PIVH	1.58	0.73 a 3.42	0.234	–	–	–
	Late sepsis	1.78	0.84 a 3.79	0.126	–	–	–
	NEC	0.06	0.06 a 1.28	0.132	–	–	–
	BPD	2.42	0.74 a 8.77	0.153	–	–	–
	ROP	0.98	0.33 a 2.87	0.980	–	–	–
	Death	2.02	0.78 a 5.26	0.141	–	–	–

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[1] *Corresponding author. E-mail: rafaellecristineoc@gmail.com (R. C. O. Cordeiro).

Maternal data (n=133)
	Mother’ temperature (°C) – mean±SD	36.1±0.8
	Peripartum hemorrhage – n (%)	18 (13.5)
	Single pregnancy – n (%)	110 (82.7)
	Cesarean delivery – n (%)	96 (72.2)
Neonatal data (n=149)
	Gestational age (weeks) – mean±SD	27.8±2.5
	Male – n (%)	74 (49.7)
	Weight (grams) – mean±SD	971±280
	1st minute Apgar <7 – n (%)	87 (58.4)
	5th minute Apgar <7 – n (%)	21 (14.1)