Admission temperature and neonatal outcomes - single-centre experience in Saudi Arabia

Abstract

This study aimed to investigate the association between admission hypothermia (AH), neonatal mortality and major neonatal morbidities in preterm infants <33 weeks' gestation. An additional aim of the study was to examine changes in the prevalence of admission hypothermia after the initiation of a thermoregulation quality improvement (QI) project. This is a retrospective cohort study of preterm infants < 33 weeks' gestation born at King AbdulAziz Medical City Riyadh (KAMC-R) between January 2017 to December 2020. Eight-hundred infants were born during the study period. Four hundred and one infants (50.1%) had an admission temperature of <36.5°C and a further 399 (49.9%) had an admission temperature of >36.5°C. The mortality before discharge was 15.7% in infants with AH compared to 4.8% among those with an admission temperature above 36.5°C. This remained statistically significant after adjustments for gestational age and maternal PET status on a multivariate analysis (P=.001, OR 2.7,95%CI 1.5-4.7). The need for mechanical ventilation (P=.005) and incidence of surgical NEC (P=.030) were significantly different between the two temperature groups. Mean (SD) admission temperature increased from 36.3°C to 36.6°C following the thermoregulation intervention program (P <.001). Admission temperature <36°C is associated with higher mortality in the first week (P=.001, OR 3.3,95% CI (1.7-6.6)) and increased incidence of cystic PVL (P=.04, OR 2.1, CI (1.03-4.3)). Preterm infants with AH suffered higher mortality and greater neonatal morbidities.