Admission Temperature Research Articles

Use of Heated Humidified Gases for Early Stabilization of Preterm Infants: A Meta-Analysis

Background: Large observational studies in preterm infants have shown an increase in mortality and morbidity when admission temperature is below 36.5°C. Recent randomized controlled studies have shown a reduction in admission hypothermia and an increase in the number of infants admitted with normal temperature (36.5–37.5°C) when heated humidified gases were used for initial stabilization of preterm infants.Objective: The goal of this study was to perform a meta-analysis of published randomized trials using heated humidified gas compared to cold dry gas in preterm infants immediately after birth and during transport to the neonatal unit. Specific research aims were to determine the magnitude of the reduction in hypothermia and to examine neonatal outcomes including mortality.Methods: A literature search was conducted in accordance with the standard methods of the Cochrane Neonatal Work Group. Randomized trials were identified and data entered into RevMan5. A fixed effects statistical model was used. Risk of bias was assessed for included studies and the GRADE approach used to determine quality of evidence. The primary outcome was admission hypothermia (< 36.5°C). Secondary outcomes included admission temperature in the normothermic range (36.5–37.5°C) and neonatal outcomes including mortality.Results: Two studies met inclusion criteria and a total of 476 preterm infants were enrolled, all of whom were < 32 weeks gestation. Studies were not blinded but the overall risk of bias was low. Admission hypothermia was reduced by 36% (CI 17–50%), while admission normothermia was significantly increased. GRADE quality of evidence was high for these outcomes. The number of infants with more severe hypothermia (< 35.5°C) was significantly reduced (RR 0.32 CI 0.14-0.73). In addition, preterm infants < 28 weeks had significantly less admission hypothermia (RR 0.61 CI 0.42, 0.90) Mortality and measures of respiratory outcome were not significantly different (studies were not powered for these outcomes), though there was a trend to improvement in all respiratory measures assessed. There were no significant adverse events and no increase in admission hyperthermia (>37.5°C).Conclusions: Heating and humidification of inspired gases immediately after birth and during transport to the neonatal unit improves admission temperature in preterm infants. Consideration should be given to incorporating this technique into other strategies (e.g., use of plastic wrap) designed to keep preterm infants warm on admission to the neonatal unit.

Successful implementation of an intracranial hemorrhage (ICH) bundle in reducing severe ICH: a quality improvement project.

Our specific, measurable, attainable, relevant, and time-limited (SMART) aim was to reduce the incidence of severe intracranial hemorrhage (ICH) among preterm infants born <30 weeks' gestation from a baseline of 24% (January 2012-December 2013) to a long-term average of 11% by December 2015. We instituted an ICH bundle consisting of elements of the "golden hour" (delayed cord clamping, optimized cardiopulmonary resuscitation, improved thermoregulation) and provision of cluster care in the neonatal intensive care unit (NICU). We identified key drivers to achieve our SMART aims, and implemented quality improvement (QI) cycles: initiation of the ICH bundle, education of NICU staff, and emphasis on sustained adherence. We excluded infants born outside our facility and those with congenital anomalies. Using statistical process control analysis (p-chart), the ICH bundle was associated with successful reduction in severe ICH (grade 3-4) in our NICU from a prebundle rate of 24% (January 2012-December 2013) to a sustained reduction over the next 4 years to an average rate of 9.7% by December 2017. Results during 2016-2017 showed a sustained improvement beyond the goal for 2014-2015. Over the same interval, there was improvement in admission temperatures [median 36.1 °C (interquartile range: 35.3-36.7 °C) vs. 37.1 °C (36.8-37.5 °C), p < 0.01] and a decrease in mortality rate [pre: 16/117 (14%) vs. post: 16/281 (6%), P < 0.01]. Our multidisciplinary QI initiative decreased severe ICH in our institution from a baseline rate of 24% to a lower rate of 9.7% over the ensuing 4 years. Intensive focus on sustained implementation of an ICH bundle protocol consisting of improved delivery room management, thermoregulation, and clustered care in the NICU was temporally associated with a clinically significant reduction in severe ICH.

"Golden Hour" quality improvement intervention and short-term outcome among preterm infants.

To evaluate the impact of a quality improvement intervention during the first hour of life ("Golden Hour") on short-term preterm neonatal outcome. A comprehensive protocol designed for initial stabilization and treatment of preterm infants that included cord blood sampling, use of a dedicated resuscitation room and improved team communication using Crew Resource Management tools. The infants admitted before and after implementation of the protocol were retrospectively compared in a matched case-control design. There were 194 infants in the intervention group and 194 controls. Admission temperatures improved significantly from a mean of 35.26 °C to 36.26 °C (P < 0.001), and late-onset sepsis and bronchopulmonary dysplasia rates lowered significantly (P = 0.035 and P = 0.028, respectively) in the intervention group. There was trend towards reduction in early blood transfusion and ventilation duration. A "Golden Hour" quality improvement intervention was of significant benefit for preterm neonates. Further follow-up to assess long-term effects is warranted.

Admission temperature and hospital outcomes in extremely preterm infants

To evaluate trends in admission temperature and its effect on mortality and short-term morbidities in extremely preterm infants. A regional cohort study of infants born at 23-28 weeks' gestation and admitted to the 10 neonatal intensive care units in New South Wales and the Australian Capital Territory between 1994 and 2012. Hypothermia was defined as skin temperature <36°C on admission to the neonatal intensive care unit. The primary outcome was hospital mortality. In total, 6267 infants were included. Mean admission temperatures improved significantly from 35.6°C in 1994 to 36.4°C in 2012 (R < 0.88). The incidence of hypothermia was 29.5 and 13.9% between 1994-2005 and 2006-2012, respectively. In comparison with normothermic infants, hypothermic infants had lower gestational age at birth (26 vs. 27 weeks) and lower birthweight (800 vs. 976 g). In-hospital mortality was higher in hypothermic infants (28.5 vs. 12.9%; odds ratio (OR) 2.69, 95% confidence interval (CI) 2.37-3.06). Severe intraventricular haemorrhage (12.1 vs. 8.5%, OR 1.48, 95% CI 1.25-1.75), necrotising enterocolitis (NEC) (11.0 vs. 7.5%; OR 1.54, 95% CI 1.29-1.83) and severe retinopathy of prematurity (16.5 vs. 8.9%; OR 2.02, 95% CI 1.70-2.39) were significantly higher in hypothermic infants. Multivariate regression analysis showed hypothermia was an independent risk factor for increased mortality (AOR (adjusted odds ratio ) 1.50, 95% CI 1.29-1.74, P < 0.001) and NEC (AOR 1.28, 95% CI 1.05-1.55, P = 0.01). Admission temperatures improved during the time period. Hypothermia at admission was associated with a significant increase in mortality and NEC.

Clinical spectrum and short-term outcome of adult patients with purpura fulminans: a French multicenter retrospective cohort study.

Data on purpura fulminans (PF) in adult patients are scarce and mainly limited to meningococcal infections. Our aim has been to report the clinical features and outcomes of adult patients admitted in the intensive care unit (ICU) for an infectious PF, as well as the predictive factors for limb amputation and mortality. A 17-year national multicenter retrospective cohort study in 55 ICUs in France from 2000 to 2016, including adult patients admitted for an infectious PF defined by a sudden and extensive purpura, together with the need for vasopressor support. Primary outcome variables included hospital mortality and amputation during the follow-up period (time between ICU admission and amputation, death or end of follow-up). Among the 306 included patients, 126 (41.2%; 95% CI 35.6-46.9) died and 180 (58.8%; 95% CI 53.3-64.3) survived during the follow-up period [13 (3-24)days], including 51/180 patients (28.3%, 95% CI 21.9-35.5) who eventually required limb amputations, with a median number of 3 (1-4) limbs amputated. The two predominantly identified microorganisms were Neisseria meningitidis (63.7%) and Streptococcus pneumoniae (21.9%). By multivariable Cox model, SAPS II [hazard-ratio (HR) = 1.03 (1.02-1.04); p < 0.001], lower leucocytes [HR 0.83 (0.69-0.99); p = 0.034] and platelet counts [HR 0.77 (0.60-0.91); p = 0.007], and arterial blood lactate levels [HR 2.71 (1.68-4.38); p < 0.001] were independently associated with hospital death, while a neck stiffness [HR 0.51 (0.28-0.92); p = 0.026] was a protective factor. Infection with Streptococcus pneumoniae [sub-hazard ratio 1.89 (1.06-3.38); p = 0.032], together with arterial lactate levels and ICU admission temperature, was independently associated with amputation by a competing risks analysis. Purpura fulminans carries a high mortality and morbidity. Pneumococcal PF leads to a higher risk of amputation. NCT03216577.

Standard care with plastic bag or portable thermal nest to prevent hypothermia at birth: a three-armed randomized controlled trial.

To assess the efficacy of adding plastic bag or portable thermal nest (PTN) to standard care in preventing hypothermia soon after birth in 1500-2499 g infants. Infants were randomized into standard thermal care alone, plastic bag with standard care or PTN with standard care. Axillary temperature was measured at admission and every 30 min till euthermia. All babies were followed-up till day 7. We recruited 300 infants: plastic bag (101), PTN (99) and standard care group (100). Admission temperature was 36.4 °C (0.52) in plastic bag group, 36.3 °C (0.50) in PTN and 36.1 °C (0.59) in standard care group (p < 0.001). Incidence of hypothermia was lowest in plastic bag group (44.6%), followed by PTN (60%) and standard care (67%). Secondary outcomes were comparable. Addition of plastic bag or PTN to standard care significantly reduces incidence and duration of hypothermia soon after birth. Plastic bag is more effective than PTN.

Patient reported symptoms, body temperature and hospital mortality: an observational study in a low resource healthcare environment.

Fever is a common presenting complaint of patients, especially in sub-Saharan Africa. Although most medical authorities consider fever to be synonymous with an elevated body temperature the relationship of the complaint of fever made by patients to temperature has not been well defined. This study examined the relationship of the complaint of fever to temperature on and after admission and in-hospital mortality. Observational study in a low-resource Ugandan mission hospital. Out of 2122 alert patients admitted between 9 August 2016 and 5 January 2018, 349 (16.4%) complained of fever: these patients were no more likely to have an abnormal temperature or die in-hospital than those not complaining of fever. Of the 707 alert patients admitted after 1 July 2017, 422 were interviewed in detail about their symptoms: only rigors, feeling intermittently hot and cold, and anorexia were statistically related to the complaint of fever, and only rigors to an admission temperature >38°C. No symptom or sign was associated with a temperature ≤36°C: cold and clammy skin was the only finding associated with in-hospital death. On logistic regression the only independent predictors of mortality were: the National Early Warning Score, impaired mobility on presentation and cold and clammy skin. In this study, the term fever used by patients and raised body temperature were not synonymous. Although fever and related symptoms reported by patients are common presenting complaints only the finding of cold and clammy skin was associated with in-hospital mortality.

Effectiveness of a measure program to prevent admission hypothermia in very low‐birth weight preterm infants

ObjectiveTo evaluate the effectiveness of a thermoregulation bundle for preventing admission hypothermia in very low‐birth weight preterm infants. MethodsInterventional study with retrospective evaluation of data undertaken in a tertiary neonatal unit including all very low‐birth weight preterm infants (<1500g) born at and admitted to the unit. Two periods were compared: before intervention (PI; 01/01/2012 to 02/28/2014_ and after intervention (PII; 04/01/2014 to 11/30/2016). The intervention started in March 2014. At PI procedures in the delivery room were: placement in a crib with a radiant heat source, doors always closed, polyethylene body plastic bag, double cap (plastic and cotton mesh), room temperature between 24 to 27°C and transport to neonatal unit in a pre‐heated incubator (36–37.0°C). At PII, there was a reinforcement on not opening the plastic bag during the entire resuscitation process, even at an advanced stage, and the anthropometric measures and routine care were performed in the neonatal unit. Maternal, delivery, and neonatal variables were compared. Admission hypothermia was considered when admission axillary temperature was <36.0°C. Periodic results were shown to the team every six months and results were discussed. ResultsThe incidence of admission hypothermia was reduced significantly in PII (37.2 vs. 14.2%, p<0.0001) and admission temperature medians were higher (36.1 vs. 36.5°C, p<0.001). At PII, there was an increase in the number of infants transported with oxygen (49.5 vs. 75.5%, p<0.0001). No differences were observed regarding birth weight and gestational age. ConclusionThere was a very important reduction in admission hypothermia incidence and a higher median admission temperature after continued protocol implementation.

Association of admission temperature and death or adverse neurodevelopmental outcomes in extremely low-gestational age neonates.

Preterm infants are at higher risk of developing hypothermia and complications from cold stress, resulting in high mortality and short-term morbidity. Our objective is to evaluate the association between admission temperatures of extremely low-gestational age neonates (ELGAN) (<29 weeks') and adverse short-term neurodevelopmental outcomes. In this retrospective study, we included ELGAN admitted to NICUs across Canada between April 2009 and September 2011, who underwent neurodevelopmental assessment at 18-21 months' corrected age. Of 2739 infants with a complete data set identified during the study period, 968 (35.3%) had admission temperatures ≤36.4 °C (hypothermia group), 1489 (54.5%) had temperature of 36.5-37.2 °C (normothermia group), and 282 (10.3%) had hyperthermia (≥37.3 °C). Their mean birth weight was 823 ± 230 g, 944 ± 227 g and 927 ± 223 g, respectively (p < 0.01). More than 50% of infants born at 23-24 weeks were in the hypothermic group compared to 28.5-36.1% at higher gestational ages. We found 39.5% of infants in the hypothermic group had primary composite outcome of death or severe neurodevelopmental impairment (sNDI). Multivariate logistic regression revealed an increased adjusted odd of primary composite outcome (OR = 1.32; 95% CI = [1.05, 1.66]) in the hypothermic group, compared to infants with normothermia on admission. In our cohort of ELGAN, hypothermia on admission was associated with increased risk of death or sNDI.

Efficacy of passive hypothermia and adverse events during transport of asphyxiated newborns according to the severity of hypoxic‐ischemic encephalopathy

ObjectiveTo determine if the efficacy of passive hypothermia and adverse events during transport are related to the severity of neonatal hypoxic‐ischemic encephalopathy. MethodsThis was a retrospective study of 67 infants with hypoxic‐ischemic encephalopathy, born between April 2009 and December 2013, who were transferred for therapeutic hypothermia and cooled during transport. ResultsFifty‐six newborns (84%) were transferred without external sources of heat and 11 (16%) needed an external heat source. The mean temperature at departure was 34.4±1.4°C and mean transfer time was 3.3±2.0h. Mean age at arrival was 5.6±2.5h. Temperature at arrival was between 33 and 35°C in 41 (61%) infants, between 35°C and 36.5°C in 15 (22%) and <33°C in 11 (16%). Infants with severe hypoxic‐ischemic encephalopathy had greater risk of having an admission temperature<33°C (OR: 4.5; 95% CI: 1.1–19.3). The severity of hypoxic‐ischemic encephalopathy and the umbilical artery pH were independent risk factors for a low temperature on admission (p<0.05). Adverse events during transfer, mainly hypotension and bleeding from the endotracheal tube, occurred in 14 infants (21%), with no differences between infants with moderate or severe hypoxic‐ischemic encephalopathy. ConclusionThe risk of overcooling during transport is greater in newborns with severe hypoxic‐ischemic encephalopathy and those with more severe acidosis at birth. The most common adverse events during transport are related to physiological deterioration and bleeding from the endotracheal tube. This observation provides useful information to identify those asphyxiated infants who require closer clinical surveillance during transport.

Quality Improvement Initiative to Prevent Admission Hypothermia in Very-Low-Birth-Weight Newborns

ObjectiveTo decrease rates of admission hypothermia (<36 °C) in very-low-birth-weight (VLBW) newborns (<1,500 g). DesignQuality improvement initiative. Setting/Local ProblemUrban, Level IV NICU with 32 patient beds. The number of VLBW newborns admitted with temperatures less than 36 °C was greater than in comparable NICUs in the Vermont Oxford Network. ParticipantsNeonates born in 2016 who weighed less than 1,500 g at birth. Intervention/MeasurementsBased on the literature and the needs of our unit, our team decided to focus efforts on equipment (chemical mattresses and polyurethane-lined hats for newborns who weighed <1,000 g and polyurethane-lined hats for newborns who weighed <1,500 g), staff education/awareness, and temperature documentation and workflow. Axillary temperature measurements for all neonates who weighed less than 1,500 g were tracked on admission. ResultsThe processes involved in this quality improvement initiative were successfully implemented, and use of new equipment began January 1, 2016. In 2016, only 9.6% (n = 7) of VLBW newborns were admitted with temperatures less than 36 °C, compared with 20.2% (n = 19) in 2015 and 32.4% (n = 24) in 2014 (p = .003). Overall, the mean admission temperature for neonates who weighed less than 1,500 g rose from 36.2 °C in 2014 to 36.6 °C in 2016 (p = .001). ConclusionWe reduced the number of VLBW neonates admitted with temperatures less than 36 °C and increased overall admission temperatures for neonates who weighed less than 1,500 g with the addition of polyurethane-lined hats and chemical mattresses.

Maintaining normothermia: Why and how?

A high incidence of postnatal hypothermia has been reported in high-as well low-resource countries and it remains an independent predictor of neonatal morbidity and mortality, especially in very preterm infants in all settings. The temperature of newly born infants should be maintained between 36.5 and 37.5 °C after birth through admission and stabilization. Interventions to achieve this may include environmental temperature 23–25 °C, use of radiant warmers, exothermic mattresses, woollen or plastic caps, plastic wraps, humidified and heated gases. Skin-to-skin contact has been used, especially in low-resource settings. The combinations of these interventions applied to quality improvement initiatives, including staff training, use of checklists, and continuous feedback with the staff involved in the management of the neonate, are key factors to prevent heat loss from delivery room to admission to the neonatal intensive care unit. The admission temperature should be recorded as a predictor of outcomes as well as a quality indicator.

Dual analysis for heat exchange: Application to thermal bridges

The research presented in this article is a contribution to the characterization of thermal dual analysis.The aim of a dual analysis based on two complementary numerical methods is to calculate the stationary temperature field. The two methods are respectively the classical Kinetically Admissible (KA) finite element or temperature method, and the Statically Admissible (SA) flow method.The originality of this work is twofold. First, it uses a flow approach (SA) in 2D and 3D that naturally respects flow conservation (in contrast to the KA method). Second, calculating the dissipation energy allows the exact solution of a problem to be enclosed, with the lower and upper bounds being calculated respectively by the KA and SA methods.Thermal bridges are areas of risk in the building walls, because they can give rise to uncontrolled increments in heat transfer. A number of studies have looked at thermal bridges, but much of the numerical code for building energy simulations uses heat transfer models based on one-dimensional heat flow analysis. Fabrizio Ascione (2014) showed that this can lead to unreliable results. The originality of this paper is to consider 2D and 3D thermal bridges using dual analysis with mesh sizes smaller than those used in conventional finite element approaches.

Investigations of Heat and Mass Transfer for Thermal Protection Materials in a Long Flight

The problem of unsteady coupled heat and mass transfer in the course of motion of a spherically blunted conical body fabricated with the use of thermal protection materials is considered. Numerical integration is applied to study the characteristics of heat and mass transfer at constant stagnation parameters (Mach number 6, altitude 15 km, and flight time 600 s), which impose severe constraints on the choice of materials for thermal protection. It is demonstrated that the use of advanced ceramic materials ensures an admissible temperature regime and maintaining the initial geometry of the body, including its motion at an angle of attack.

A Quality Initiative for Optimal Therapeutic Hypothermia during Transport for Neonates with Neonatal Encephalopathy.

Introduction:Neuroprotection with therapeutic hypothermia (TH) is standard of care for neonatal encephalopathy (NE) and decreases death and neurodevelopmental disability. TH initiated shortly after birth insult results in greater neuroprotection compared with delayed initiation.Methods:Quality improvement methodology was used to improve temperature control during transport to a level IV neonatal intensive care unit. We included neonates with NE transported to a single institution for TH from 2010 to 2016. The quality improvement interventions were 2-fold. Review of the Transport Body Cooling Protocol revealed a suboptimal temperature goal of 34–35°C; this protocol was revised to 33–34°C. The second intervention was the implementation of an active cooling protocol. Clinical characteristics were compared using 2-sample t tests for continuous variables and Fisher’s exact tests for categorical variables; statistical process control chart was used to monitor admission temperatures.Results:We obtained baseline data for 78 neonates admitted from 2010 to 2014. These data were compared with postintervention data for 26 patients admitted between 2015 and 2016. Distance transported, NE severity, and seizures were similar between the 2 groups. The use of active cooling increased from 8% preimplementation to 31% postimplementation (P < 0.01). After implementation of the 2 interventions, more infants were admitted within the goal temperature of 33–34°C, 58% versus 22% (P < 0.01), and the average neonatal intensive care unit admission temperature improved from 34.4 ± 0.8°C to 33.8 ± 0.8°C (P < 0.01).Conclusion:Increased utilization of active cooling during transport for TH improves the percentage of neonates admitted within the target temperature range. However, 42% of neonates remained outside the target temperature range, supporting the need for additional tools to improve admission temperatures.

Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants.

Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants.

Converting Primary Resources into Useful Energy: The Pollution Ceiling Efficiency Paradox

We study an economy producing energy services from a polluting fossil fuel and a carbon free renewable resource under a constraint on the admissible atmospheric carbon concentration, equivalently under a constraint on the admissible temperature. The transformation rates of natural primary resources energy into useful energy are costly endogenous variables. Choosing higher efficiency rates requires to bring into operation more sophisticated energy transformation devices, that is more costly ones. We show that, independently of technical progress, along an optimal path, the transformation rate of any exploited resource should increase throughout time, excepted within the period during which the carbon constraint is binding, a phenomenon we call the ‘ceiling paradox’. The effects of technical progress in the fossil fuel and the renewable energy sectors are strongly contrasted. JEL Codes: Q00, Q32, Q43, Q54. Keywords: Energy Efficiency, Carbon Pollution, Non-Renewable Resources, Renewable Resources.

Analysis of minimum ignition temperature of pellet dust layer and cloud due to adding BC and ABC fire extinguishing powders

The paper describes the impact of adding fire extinguishing powders acting based on oxygen or flame on values of minimum ignition temperatures of the layer and cloud of pellet dust, and as a consequence the impact or lack of impact on values of maximum admissible temperature on external surfaces of electrical appliances working in their atmospheres. Tests were conducted of the minimum ignition temperature of layer and cloud of the agro armakow pellet dust and the agro jesień pellet dust, with and without additives of fire extinguishing powders BC Jet, BC LB2, ABC 90 and Ogniotex 103 at concentrations ranging from 5 to 70% by weight of powder contents in the mixture. Based on obtained test results it has been ascertained that type ABC powders appear to be much more effective than those type BC, because they have a much bigger impact on increasing the minimum ignition temperature of the layer and the cloud of analysed dust types. Adding only 15% of ABC 90 extinguishing powder to the agro jesień pellet has caused an increase in the minimum ignition temperature of dust layer by 80°C. The BC LB2 powder with agro armakow pellet dust has not been found to cause any changes, even at its concentration as high as 70%. The most optimum additive of powder to the biomass dust was 10% by weight of ABC powder in the mixture. At this concentration the highest increase was recorded in the maximum admissible temperature on the outer surface of electrical appliances from 235°C to 273°C.

Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants

To evaluate the temperature distribution among moderately preterm (MPT, 29-33 weeks) and extremely preterm (EPT, <29 weeks) infants upon neonatal intensive care unit (NICU) admission in 2012-2013, the change in admission temperature distribution for EPT infants between 2002-2003 and 2012-2013, and associations between admission temperature and mortality and morbidity for both MPT and EPT infants. Prospectively collected data from 18 centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were used to examine NICU admission temperature of inborn MPT and EPT infants. Associations between admission temperature and mortality and morbidity were determined by multivariable logistic regression. EPT infants from 2002-2003 and 2012-2013 were compared. MPT and EPT cohorts consisted of 5818 and 3213 infants, respectively. The distribution of admission temperatures differed between the MPT vs EPT (P < .01), including the percentage <36.5°C (38.6% vs 40.9%), 36.5°C-37.5°C (57.3% vs 52.9%), and >37.5°C (4.2% vs 6.2%). For EPT infants in 2012-2013 compared with 2002-2003, the percentage of temperatures between 36.5°C and 37.5°C more than doubled and the percentage of temperatures >37.5°C more than tripled. Admission temperature was inversely associated with in-hospital mortality. Low and high admission temperatures are more frequent among EPT than MPT infants. Compared with a decade earlier, fewer EPT infants experience low admission temperatures but more have elevated temperatures. In spite of a change in distribution of NICU admission temperature, an inverse association between temperature and mortality risk persists.

The application effect of exothermic mattress to prevent hypothermia in preterm infants: a Meta-analysis

Objective To evaluate the effects of exothermic mattress to prevent hypothermia in preterm infants. Methods SinoMed, Wanfang data, CNKI, VIP, PubMed, Embase and Web of Science were searched to collect relevant randomized or quasi randomized controlled trials on application of exothermic mattress to prevent hypothermia in preterm infants from database establishment to April 2017. A Meta-analysis was conducted by using RevMan 5.3 software. Results Four studies were included. The Meta-analysis showed that application of exothermic mattress significantly improved admission temperature in neonatal intensive care unit for infants less than 28 weeks (random effect model, weighted mean difference was 0.64, 95%CI 0.04-1.24, P=0.04) and increased risk of hyperthermia (fixed effect model, odds ratio was 3.18, 95%CI 1.30-7.77, P=0.01). Conclusions Exothermic mattress is efficacious in improving admission temperature for preterm infants. Key words: Preterm infant; Exothermic mattress; Meta-analysis