Association Between Admission Temperature and Mortality and Major Morbidity in Preterm Infants Born at Fewer Than 33 Weeks' Gestation
Association Between Admission Temperature and Mortality and Major Morbidity in Preterm Infants Born at Fewer Than 33 Weeks' Gestation
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DOI：
10.1001/jamapediatrics.2015.0277
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发表时间：
2015-04-01
期刊：
影响因子：
26.1
通讯作者：
Lee, Shoo K.
中科院分区：
文献类型：
--
作者：
Lyu, Yanyu;Shah, Prakesh S.;Lee, Shoo K.
新生儿体温过低与较高的死亡率和发病率有关，因此，分娩后的温度控制是新生儿护理的重要组成部分。确定早产儿出生后最初几个小时的理想体温可能有助于降低不良结局的风险。目的：研究入院温度与新生儿结局之间的关系，并估计与妊娠少于33周的早产儿不良结局发生率最低相关的入院温度。在加拿大新生儿网络的29个新生儿重症监护病房进行回顾性观察研究。参与者包括9833名出生时妊娠小于33周的新生儿，他们在2010年1月1日至2012年12月31日期间入院。暴露入院时记录腋窝或直肠体温。主要结局和指标主要结局是复合不良结局，定义为死亡率或以下任何一项：严重神经损伤、严重早产儿视网膜病变、坏死性小肠结肠炎、支气管肺发育不良或医院感染。结果9833例新生儿入院时体温低于34.5 ℃（1%），34.5 ~ 34.9 ℃（1%），34.5 ~ 34.9 ℃（1%），34.5 ~ 34.9 ℃（1%）。摄氏35.0度至摄氏35.4度（百分之三）;摄氏35.5度至摄氏35.9度（百分之七）;摄氏36.0度至摄氏36.4度（百分之二十四）;摄氏36.5度至摄氏36.9度（百分之三十八）;摄氏37.0度至摄氏37.4度（百分之十九）; 37.5摄氏度至37.9摄氏度（5%）;及38.0摄氏度或以上（2%）。校正了母亲和婴儿的特征后，复合结局、严重神经损伤、早产儿严重视网膜病变、坏死性小肠结肠炎、支气管肺发育不良和医院感染的发生率与入院温度呈U型关系（α> 0 [ P < .05]）。综合结局发生率最低的入院温度为36.8 ℃（95%CI，36.7 ℃-37.0 ℃）。重度神经损伤、重度早产儿视网膜病变、坏死性小肠结肠炎的发生率（95% CI，36.3 ℃-36.7 ℃）、支气管肺发育不良和医院感染（95%可信区间，36.9摄氏度-37.3摄氏度）在入院温度范围为36.5 ℃至37.2 ℃时最低。结论和相关性温度和不良新生儿结局呈U形。最低的不良结局发生率与入院温度在36.5 ℃至37.2 ℃之间相关。
IMPORTANCE Neonatal hypothermia has been associated with higher mortality and morbidity; therefore, thermal control following delivery is an essential part of neonatal care. Identifying the ideal body temperature in preterm neonates in the first few hours of life may be helpful to reduce the risk for adverse outcomes.OBJECTIVES To examine the association between admission temperature and neonatal outcomes and estimate the admission temperature associated with lowest rates of adverse outcomes in preterm infants born at fewer than 33 weeks' gestation.DESIGN, SETTING, AND PARTICIPANTS Retrospective observational study at 29 neonatal intensive care units in the Canadian Neonatal Network. Participants included 9833 inborn infants born at fewer than 33 weeks' gestation who were admitted between January 1, 2010, and December 31, 2012.EXPOSURE Axillary or rectal body temperature recorded at admission.MAIN OUTCOMES AND MEASURES The primary outcome was a composite adverse outcome defined as mortality or any of the following: severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, or nosocomial infection. The relationships between admission temperature and the composite outcome as well as between admission temperature and the components of the composite outcome were evaluated using multivariable analyses.RESULTS Admission temperatures of the 9833 neonates were distributed as follows: lower than 34.5 degrees C (1%); 34.5 degrees C to 34.9 degrees C (1%); 35.0 degrees C to 35.4 degrees C (3%); 35.5 degrees C to 35.9 degrees C (7%); 36.0 degrees C to 36.4 degrees C (24%); 36.5 degrees C to 36.9 degrees C (38%); 37.0 degrees C to 37.4 degrees C (19%); 37.5 degrees C to 37.9 degrees C (5%); and 38.0 degrees C or higher (2%). After adjustment for maternal and infant characteristics, the rates of the composite outcome, severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, and nosocomial infection had a U-shaped relationship with admission temperature (alpha > 0 [ P < .05]). The admission temperature at which the rate of the composite outcome was lowest was 36.8 degrees C (95% CI, 36.7 degrees C-37.0 degrees C). Rates of severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis (95% CI, 36.3 degrees C-36.7 degrees C), bronchopulmonary dysplasia, and nosocomial infection (95% CI, 36.9 degrees C-37.3 degrees C) were lowest at admission temperatures ranging from 36.5 degrees C to 37.2 degrees C.CONCLUSIONS AND RELEVANCE The relationship between admission temperature and adverse neonatal outcomes was U-shaped. The lowest rates of adverse outcomes were associated with admission temperatures between 36.5 degrees C and 37.2 degrees C.