Body temperature instability and respiratory morbidity in the very low birth weight infant: a multiple case, intensive longitudinal study.
Body temperature instability and respiratory morbidity in the very low birth weight infant: a multiple case, intensive longitudinal study.
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DOI：
10.1186/s12887-020-02351-y
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发表时间：
2020-10-20
期刊：
影响因子：
2.4
通讯作者：
Brandon DH
中科院分区：
文献类型：
--
作者：
Ralphe JL;Silva SG;Dail RB;Brandon DH
新生儿重症监护病房入院时极低出生体重（VLBW）婴儿的热不稳定与呼吸系统疾病相关；然而，持续的热不稳定性与呼吸系统疾病之间的关联仍不清楚。对 12 名极低出生体重婴儿进行了纵向数据分析。慢性呼吸道疾病风险定义为经期后 36 周时补充氧气需求 (FiO2) 或预定利尿剂剂量。急性呼吸系统发病率被量化为饱和度降低（SpO2<90%）、伴随饱和度降低的心动过缓（HR<100 且 SpO2<90%）、呼吸暂停、FiO2 需求增加或呼吸支持增加。多层次、混合效应模型和回归分析检查了生命前 14 天的体温与呼吸道疾病之间的关系。体温与慢性呼吸道疾病风险无关（p=0.2765）。饱和度降低、伴随饱和度降低的心动过缓、FiO2 需求增加和呼吸支持增加与体温降低相关（p<0.05）。呼吸暂停与体温升高相关（p<0.05）。低体温发作期间，经协变量调整后的去饱和风险 (aOR=1.3)、伴有去饱和的心动过缓 (aOR=2.2)、FiO2 需求增加 (aOR=1.2) 和呼吸支持增加 (aOR=1.2) 的风险显着增加。极低出生体重儿的最佳生长和发育依赖于中性热环境。因此，体温过低与急性呼吸道疾病症状之间的显着关联需要进一步研究，以确定这些是否是可以随着临床实践的变化而减弱的因果关系，或者这些是否是在生理不稳定发作期间聚集的并发症状。
Very low birth weight (VLBW) infant thermal instability upon neonatal intensive care unit admission has been associated with respiratory morbidity; however, the association between ongoing thermal instability and respiratory morbidity remains unclear. A longitudinal data analysis was conducted on 12 VLBW infants. Chronic respiratory morbidity risk was defined as supplemental oxygen requirement (FiO2) or scheduled diuretic dosing at 36 weeks post-menstrual age. Acute respiratory morbidity was quantified as desaturations (SpO2<90%), bradycardia with desaturations (HR<100 and SpO2<90%), apnea, increase in FiO2 requirement, or increase in respiratory support. Multi-level, mixed-effects models and regression analysis examined the relationships between body temperature over the first 14 days of life and respiratory morbidities. Body temperature was not associated with chronic respiratory morbidity risk (p=0.2765). Desaturations, bradycardia with desaturations, increased FiO2 requirement, and increased respiratory support were associated with decreased body temperature (p<0.05). Apnea was associated with increased body temperature (p<0.05). The covariate-adjusted risk of desaturations (aOR=1.3), bradycardia with desaturations (aOR=2.2), increase in FiO2 requirement (aOR=1.2), and increase in respiratory support (aOR=1.2) were significantly greater during episodes of hypothermia. VLBW infants are dependent on a neutral thermal environment for optimal growth and development. Therefore, the significant associations between hypothermia and symptoms of acute respiratory morbidity require further study to delineate if these are causal relationships that could be attenuated with clinical practice changes, or if these are concurrent symptoms that cluster during episodes of physiological instability.
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