Elevated temperature after hypoxic-ischemic encephalopathy: risk factor for adverse outcomes.
Elevated temperature after hypoxic-ischemic encephalopathy: risk factor for adverse outcomes.
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DOI：
10.1542/peds.2007-1673
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发表时间：
2008-09
期刊：
影响因子：
8
通讯作者：
National Institute of Child Health and Human Development Neonatal Research Network
中科院分区：
文献类型：
--
作者：
Laptook A;Tyson J;Shankaran S;McDonald S;Ehrenkranz R;Fanaroff A;Donovan E;Goldberg R;O'Shea TM;Higgins RD;Poole WK;National Institute of Child Health and Human Development Neonatal Research Network
确定患有缺氧缺血性脑病的足月儿死亡或中度/重度残疾的风险是否会随着出生后 6 至 78 小时内食管或皮肤温度相对较高而增加。这是 NICHD 新生儿研究网络随机试验中的一项观察性二次研究，比较了患有缺氧缺血性脑病的足月婴儿的全身冷却和常规护理（对照）。连续记录 72 小时的食道和皮肤温度。每个地点的每个婴儿的体温都是按顺序排列的。每个婴儿的高温定义为上四分位中所有温度测量值的平均值。低温类似地定义为下四分位数的平均值。结果与每组每个温度点的高温、中值和低温的三个逻辑回归中的温度相关，并根据脑病水平、性别、胎龄和种族进行调整。在对照婴儿中，72 小时内的平均食道温度为 37.2±0.7°C，所有温度中分别有 63%、22% 和 8% 的温度> 37°C、> 37.5°C 和 > 38°C。皮肤温度的平均值为 36.5±0.8°C，所有温度的 12%、5% 和 2% 分别为 > 37°C、> 37.5°C 和 > 38°C。皮肤或食道温度每升高摄氏度，死亡或残疾的几率就会增加 3.6-4 倍。在冷却组中，温度和结果之间没有关联。缺氧缺血后的常规护理期间相对较高的体温与不良结果的风险增加相关。结果可能反映潜在的脑损伤和/或温度对结果的不利影响。
To determine if the risk of death or moderate/severe disability in term infants with hypoxic-ischemic encephalopathy increases with relatively high esophageal or skin temperature occurring between 6 and 78 hours following birth. This is an observational secondary study within the NICHD Neonatal Research Network randomized trial comparing whole body cooling and usual care (control) for term infants with hypoxic-ischemic encephalopathy. Esophageal and skin temperatures were recorded serially for 72 hours. Each infant’s temperatures for each site were rank ordered. The high temperature was defined for each infant as the mean of all temperature measurements in the upper quartile. The low temperature was similarly defined as the mean of the lower quartile. Outcome was related to temperature in three logistic regressions for the high, median and low temperature at each temperature site for each group adjusting for level of encephalopathy, gender, gestational age and race. In control infants the mean esophageal temperature was 37.2±0.7°C over the 72 hours and 63, 22 and 8% of all temperatures were > 37, > 37.5 and > 38°C, respectively. For skin temperature the mean was 36.5±0.8°C and 12, 5 and 2% of all temperatures were > 37, > 37.5 and > 38°C, respectively. The odds of death or disability were increased 3.6–4 fold for each centigrade increase in the highest quartile of skin or esophageal temperature. There were no associations between temperature and outcome in the cooled group. Relatively high temperatures during usual care following hypoxia-ischemia were associated with increased risk of adverse outcome. The results may reflect underlying brain injury and/or adverse effects of temperature on outcome.
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