Body temperature, heart rate and long-term outcome of cooled infants: an observational study
Body temperature, heart rate and long-term outcome of cooled infants: an observational study
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DOI：
10.1038/s41390-021-01502-w
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发表时间：
2021-04-12
影响因子：
3.6
通讯作者：
Iwata, Osuke
中科院分区：
文献类型：
--
作者：
Tsuda, Kennosuke;Shibasaki, Jun;Iwata, Osuke
背景 低温治疗是新生儿脑病的护理标准；然而，大约二分之一的新生儿对这种治疗没有反应。最近的研究表明体温、心率和冷却婴儿的结果之间存在潜在关系。方法对 2012 年 1 月至 2016 年 12 月期间在日本婴儿冷却登记处登记的 756 名婴儿的临床数据进行分析，以评估体温、心率与不良后果（校正年龄 18 个月时死亡或严重损伤）之间的关系。结果 在单变量分析中，入院时较低的体温与不良结果相关（P < 0.001），当根据脑病和其他协变量的严重程度进行调整后，其显着性消失。在单变量（全部 P < 0.001）和多变量（分别为 P = 0.012、P < 0.001 和 P < 0.001）分析中，降温过程中较高的体温以及降温之前和过程中较高的心率与不良结果相关。结论 严重缺氧缺血可能是降温前和降温过程中心率加快以及降温前体温较低的常见原因，而降温过程中体温稍高与不良后果之间的因果关系需要在未来的研究中阐明。影响在一大群患有脑病的新生儿中，显示了体温对结果的双重作用；不良后果与入院时较低的体温和降温期间较高的体温有关。降温前和降温过程中较高的心率与不良后果相关。严重缺氧缺血可能是降温前和降温过程中心率加快以及降温前体温过低的常见原因。降温过程中体温稍高与不良后果之间关系的确切机制仍不清楚，需要在未来的研究中阐明。
Background Therapeutic hypothermia is a standard of care for neonatal encephalopathy; however, approximately one in two newborn infants fails to respond to this treatment. Recent studies have suggested potential relationships between body temperature, heart rate and the outcome of cooled infants. Methods The clinical data of 756 infants registered to the Baby Cooling Registry of Japan between January 2012 and December 2016 were analysed to assess the relationship between body temperature, heart rate and adverse outcomes (death or severe impairment at 18 months corrected age). Results A lower body temperature at admission was associated with adverse outcomes in the univariate analysis (P < 0.001), the significance of which was lost when adjusted for the severity of encephalopathy and other covariates. A higher body temperature during cooling and higher heart rate before and during cooling were associated with adverse outcomes in both univariate (all P < 0.001) and multivariate (P = 0.012, P < 0.001 and P < 0.001, respectively) analyses. Conclusions Severe hypoxia-ischaemia might be a common causative of faster heart rates before and during cooling and low body temperature before cooling, whereas causal relationships between slightly higher temperatures during cooling and adverse outcomes need to be elucidated in future studies. ImpactIn a large cohort of encephalopathic newborn infants, dual roles of body temperature to the outcome were shown; adverse outcomes were associated with a lower body temperature at admission and higher body temperature during cooling. A higher heart rate before and during cooling were associated with adverse outcomes. Severe hypoxia-ischaemia might be a common causative of faster heart rates before and during cooling and low body temperature before cooling. The exact mechanism underlying the relationship between slightly higher body temperature during cooling and adverse outcomes remains unknown, which needs to be elucidated in future studies.