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CC BY-NC-ND 4.0 · Am J Perinatol 2024; 41(16): 2298-2307
DOI: 10.1055/s-0044-1786873
Original Article

Association between Neonatal Outcomes and Admission Hypothermia among Very Preterm Infants in Chinese Neonatal Intensive Care Units: A Multicenter Cohort Study

Wenchao Hong   *
1   Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
,
Yanping Zhu   *
2   Department of Neonatology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Yanchen Wang
3   Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
,
Siyuan Jiang
4   Department of Neonatology, Children's Hospital of Fudan University, Minhang District, Shanghai, China
,
Yun Cao
4   Department of Neonatology, Children's Hospital of Fudan University, Minhang District, Shanghai, China
,
Xinyue Gu
4   Department of Neonatology, Children's Hospital of Fudan University, Minhang District, Shanghai, China
,
Shoo K. Lee
5   Maternal Infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada
,
Sheree Kuo
6   Department of Pediatrics, John A. Burns School of Medicine and Kapiolani Medical Center for Women and Children, University of Hawaii, Honolulu, Hawaii
,
Jianhua Sun
7   Department of Neonatology, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
,
Yuan Shi
8   Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
,
Chongbing Yan
1   Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
,
Mingxia Li
2   Department of Neonatology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Xiaohui Gong
1   Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
› Author Affiliations Funding This work was supported by the Canadian Institute of Health Research (CTP87518).
The funders had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
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Abstract

Objective We aimed to investigate the relationship between admission hypothermia and outcomes among very preterm infants (VPIs) in neonatal intensive care units (NICUs) in China. We also investigated the frequency of hypothermia in VPIs in China and the variation in hypothermia across Chinese Neonatal Network (CHNN) sites.

Study Design This retrospective cohort study enrolled infants with 240/7 to 316/7 weeks of gestation with an admission body temperature ≤37.5 °C who were admitted to CHNN-participating NICUs between January 1 and December 31, 2019.

Results A total of 5,913 VPIs were included in this study, of which 4,075 (68.9%) had hypothermia (<36.5 °C) at admission. The incidence of admission hypothermia varied widely across CHNN sites (9–100%). Lower gestational age (GA), lower birth weight, antenatal steroid administration, multiple births, small for GA, Apgar scores <7 at the 5th minute, and intensive resuscitation were significantly associated with admission hypothermia. Compared with infants with normothermia (36.5–37.5 °C), the adjusted odds ratios (ORs) for composite outcome among infants with admission hypothermia <35.5 °C increased to 1.47 (95% confidence interval [CI], 1.15–1.88). The adjusted ORs for mortality among infants with admission hypothermia (36.0–36.4 and <35.5 °C) increased to 1.41 (95% CI, 1.09–1.83) and 1.93 (95% CI, 1.31–2.85), respectively. Admission hypothermia was associated with a higher likelihood of bronchopulmonary dysplasia, but was not associated with necrotizing enterocolitis ≥stage II, severe intraventricular hemorrhage, cystic periventricular leukomalacia, severe retinopathy of prematurity, or sepsis.

Conclusion Admission hypothermia remains a common problem for VPIs in a large cohort in China and is associated with adverse outcomes. Continuous quality improvement of admission hypothermia in the future may result in a substantial improvement in the outcomes of VPIs in China.

Key Points

  • Admission hypothermia is common in VPIs.

  • The incidence of admission hypothermia in VPIs remains high in China.

  • Admission hypothermia is associated with adverse outcomes in VPIs.

Keywords

admission hypothermia - very preterm infants - China - outcomes - risk factors

* Contributed equally.




Publication History

Received: 22 January 2024

Accepted: 11 April 2024

Article published online:
27 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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