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Temperature & Vasomotor Tone During the First 5 Days in Preterms Less than 1000g

温度

基本信息

批准号：
7937545
负责人：
Robin Britt Dail
金额：
$ 47.86万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-03-15 至 2013-09-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7937545
关键词：
21 year old Abdomen Admission activity Age Autonomic nervous system Back Birth Birth Weight Blood Circulation Blood Vessels Blood flow Body Surface Body Temperature Brain Brain Injuries Brain hemorrhage Caring Case Study Catheters Clinical Code Computer software Consent Data Data Analyses Development Enrollment Environmental air flow Event Exhibits Extremely Low Birth Weight Infant Gestational Age Hand Heart Heat Losses Heating High temperature of physical object Hour Image Incidence Incubators Infant Infusion procedures Injury Intervention Intestines Lead Life Link Liquid substance Logistic Regressions Measurement Measures Mediating Medical Records Methods Monitor Morbidity - disease rate Necrosis Necrotizing Enterocolitis Outcome Oxygen Parents Perfusion Peripheral Physiologic Thermoregulation Physiological Physiological Processes Pregnancy Premature Infant Recovery Regulation Research Research Personnel Risk Sampling Series Skin Temperature Suction Sympathetic Nervous System System Temperature Time Time Series Analysis Translating United States Vasomotor Video Recording age group base clinical care cold temperature constriction experience foot indexing innovation instrumentation intraventricular hemorrhage mortality natural hypothermia peripheral blood postnatal premature prevent programs public health relevance response vasoconstriction

项目摘要

DESCRIPTION (provided by applicant): Objective: This study will examine maturation of vasomotor tone by measuring central and peripheral body temperature of 30 extremely low birth weight (ELBW) infants in relationship to peripheral perfusion during the first 5 days of life. We will examine the ability of each infant to exhibit peripheral vasoconstriction in response to decreased abdominal skin temperature and to keep abdominal temperature higher than peripheral using thermistor temperatures, peripheral perfusion index and infrared thermal imaging. The study will provide data on which to base a multi-center study to examine the relationship between the maturation of vasomotor tone and morbidity--intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC)--in ELBW infants. Methods: Consent will be obtained from parents prior to infant birth. ELBW infants less than 29 weeks gestation and less than 1000 gram birth-weight will be enrolled at NICU admission. Physiologic variables will be sampled every minute for 120 hours. Abdominal and peripheral body temperature will be measured using thermistors and data loggers. Peripheral blood flow will be measured using peripheral perfusion index from a Masimo Radical-7 monitor. An infrared camera will be used to measure body surface\ temperature once daily, through the incubator hood adapted for thermal imaging. Infants will be video-recorded continuously over the 5-days to capture care that may expose the infant to cold environmental temperatures. Infant medical records will be reviewed until NICU discharge. Data Analysis: Data will be analyzed using SAS software, first as case studies within-subjects, then with comparison between subjects in three gestational age groups: 23-25, 25 1/7-27, and 27 1/7-28 6/7 weeks. The State Space approach to time series analysis and logistic regression will be used to determine time of vasomotor tone maturity within each infant and average over each infant group. Time of vasomotor maturity will be determined as the age at which each infant has the ability to decrease peripheral temperature 0.5-2¿ C below abdominal temperature in response to a decrease in abdominal temperature below 37¿C and when the infant can consistently keep abdominal temperature greater than peripheral temperature. Clinical care events will be analyzed in relationship to decreases in body temperature and subsequent recovery to baseline temperature. Events causing decreased internal body temperatures may include suctioning, ventilation with an oxygen bag or infusion of fluids into umbilical catheters. Events causing decreases in external environmental temperature are related to opening the incubator portholes or doors. All events will be coded from video data and entered into analyses with physiological variables. Cross correlations will be used to compare peripheral temperature, peripheral perfusion and internal incubator temperature. Infrared thermal measurements will be compared to body temperature measured by thermistor to evaluate the use of thermal imaging for overall body temperature and perfusion. Occurrence of IVH and NEC will be related to each infant's gestational and postnatal age of vasomotor tone maturity. PUBLIC HEALTH RELEVANCE: Extremely premature infants are subject to low temperatures during their first few days of life. These infants have an increased risk for brain injury during this time that may be due to immature regulation of blood flow, increasing their neurosensory, developmental and physical risks. This study will provide evidence of the time when the ability to control blood flow to the feet and back to the brain and heart becomes mature in extremely premature infants during their first week of life, allowing interventions to be developed to decrease these developmental risks.

描述（由申请方提供）：目的：本研究将通过测量30名极低出生体重（ELBW）婴儿出生后前5天的中心和外周体温与外周灌注的关系来检查血管紧张素的成熟。我们将使用热敏电阻温度、外周灌注指数和红外热成像检查每例婴儿对腹部皮肤温度降低的外周血管收缩反应能力，以及保持腹部温度高于外周温度的能力。该研究将提供数据，作为多中心研究的基础，以检查ELBW婴儿中血管紧张素成熟与发病率-脑室内出血（IVH）和坏死性小肠结肠炎（NEC）之间的关系。方法：婴儿出生前将获得父母的同意。小于29周妊娠和小于1000克出生体重的ELBW婴儿将在NICU入院时入组。生理变量将每分钟取样一次持续120小时将使用热敏电阻和数据记录器测量腹部和外周体温。使用Masimo Radical-7监测仪的外周灌注指数测量外周血流量。红外摄像机将用于测量身体表面。通过适于热成像的孵育器罩，每天一次测量温度。将在5天内连续对婴儿进行视频记录，以记录可能使婴儿暴露于寒冷环境温度的护理。婴儿病历将被审查，直到NICU出院。数据分析：将使用SAS软件分析数据，首先作为受试者内的病例研究，然后比较三个胎龄组（23-25、25 1/7-27和27 1/7-28 6/7周）的受试者。时间序列分析和逻辑回归的状态空间方法将用于确定每个婴儿的血管紧张素成熟时间和每个婴儿组的平均值。血管成熟时间将被确定为每个婴儿能够将外周温度降低到腹部温度以下0.5-2 ℃的年龄，以响应腹部温度降低到37 ℃以下，并且婴儿能够始终保持腹部温度高于外周温度。将分析临床护理事件与体温降低和随后恢复至基线体温的关系。导致体内温度降低的事件可能包括抽吸、用氧气袋通气或将液体注入脐带导管。事件导致外部环境温度的降低与打开培养箱的孔口或门有关。所有事件将根据视频数据进行编码，并输入到生理变量分析中。将使用交叉相关性来比较外周温度、外周灌注和内部培养箱温度。将红外热测量值与热敏电阻测量的体温进行比较，以评价热成像在总体体温和灌注中的应用。IVH和NEC的发生与每个婴儿的妊娠期和出生后血管紧张素成熟年龄有关。公共卫生相关性：极早产儿在出生后的头几天会受到低温的影响。这些婴儿在此期间脑损伤的风险增加，这可能是由于血流调节不成熟，增加了他们的神经感觉，发育和身体风险。这项研究将提供证据证明，在极早产儿出生后的第一周内，控制血液流向足部并返回大脑和心脏的能力何时成熟，从而可以开发干预措施来减少这些风险。发展风险。