Admission Temperature Research Articles

Hypothermia in Preterm Infants in the First Hours after Birth: Occurrence, Course and Risk Factors.

BackgroundHypothermia is associated with increased morbidity and mortality rates. Preterm infants frequently have hypothermia when they are admitted to the NICU, but there is no data on the occurrence of hypothermia during the first hours after admission.ObjectiveTo investigate the occurrence of hypothermia in preterm infants in the first three hours of admission and to identify risk factors.MethodsInfants < 32 weeks of gestation included in a randomized trial with admission temperature as primary outcome were retrospectively analyzed for the occurrence of hypothermia (< 36.5°C) in the first three hours after admission. Risk factors were identified using linear regression analysis and logistic regression.ResultsIn total 80 infants were included with a median (IQR) gestational age at birth of 29 (27–30) weeks. In 93% of the infants hypothermia occurred in the first three hours after admission. The median (IQR) duration of hypothermia was 101 (34–162) minutes, of which 24 (7–52) minutes the hypothermia was mild, 45 (4–111) minutes moderate, severe hypothermia hardly occurred. Gestational age and the occurrence of hypothermia at birth were independent risk factors for the occurrence of moderate and severe hypothermia and significantly correlated with duration of hypothermia.ConclusionsHypothermia occurred often and for a long period in preterm infants in the first three hours of life, low gestational age and admission temperature were independent risk factors

Bundle Them up for Transport-A Quality Improvement Initiative

Hypothermia contributes to the morbidity and mortality in premature infants. The thermoregulatory needs of Extremely Low Birth Weight (ELBW) infants are especially challenging during critical care transport. We studied whether a quality improvement project utilizing a bundled group of clinical practices could improve the admission temperatures of transported ELBW infants.

Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy: temperature control during transport

This study aims to assess the adequacy of temperature control during transport of patients referred for therapeutic hypothermia at our centre and to evaluate the occurrence of complications when temperature control is not adequate. Transport data of patients (n = 37) referred during a period of 30 months was reviewed retrospectively, as well as our prospectively collected database of infants treated with hypothermia. We evaluated duration of transport, incidence of excessive cooling on admission and associated complications. Distance from the referring hospital and duration of the transport were not associated with excessive cooling. We then divided patients into two groups according to adequacy of temperature control during transport depending on the presence or absence of regular temperature recordings and compared study variables between the groups. A significant correlation was found between the lack of adequate temperature records during transport (n = 19) and excessive hypothermia on admission (42% vs. 11% for the group with adequate temperature monitoring). There was a trend towards increased incidence of coagulation problems for infants who had admission temperatures below 32.0°C. Passive cooling is simple and effective to ensure early achievement of neuroprotective temperature, but continuous temperature monitoring during transportation is mandatory in order to avoid excessive cooling.

Understanding the buckling behaviour of steered tows in Automated Dry Fibre Placement (ADFP)

Technologies for automated fibre lay-up have proven their usefulness in composites manufacturing. Further development of the technologies, such as Automated Dry Fibre Placement (ADFP), allow further reduction of waste and increase of the design space through tow steering which enables creation of composites with tailored properties. Tow steering is, however, limited by possible defects such as wrinkles which result from mismatch of fibre length and steering path. This paper addresses wrinkle formation at different steering radii and provides a closed-form solution for the problem. Experimental results are used for estimation of the model parameters and validation of the model. An analytical framework is used to explore effects of processing parameters on defect formation. It was found that the tack stiffness has the greatest influence on defect formation. Parametric studies showed that increase of the temperature within the admissible temperature window can improve the tack properties and hence improve the lay-up.

First Golden Hour of Life: A Quality Improvement Initiative.

Very low birth-weight (<1500 g) infants are vulnerable to their environment during the first hour after birth. We designed an evidence-based golden hour protocol (GHP) with a goal to stabilize and perform admission procedures within 1 hour of birth at a level IIIB neonatal intensive care unit (NICU). The aim of this quality improvement project was to ascertain whether an evidence-based GHP would improve care efficiency and short-term outcomes. Rapid cycles of change using Plan Do Study Act were utilized to document progress and gain knowledge during the quality improvement project. Measures were plotted with statistical process control methods (SPC), which analyzed improvement over time. Both admission temperature and glucose-level means were within reference range throughout the project and predicted a stable process. We observed significantly decreased time to initiation of intravenous fluids and antibiotics. An upward trend of surfactant administration within the first 2 hours of life was also observed. The use of a GHP provided an organized approach to admission procedures and care. By using a checklist and recording intervention times, NICU caregivers were more aware of time management for each intervention and were able to decrease time to initiation of intravenous fluids and antibiotics. Future research should focus on establishing normal blood pressure ranges and safe pain management during the "golden hour" and beyond. Future quality improvement should focus on improving subsequent temperature and blood glucose levels after admission umbilical artery and venous catheter placement.

Hypothermia at NICU admission in very preterm infants

Since the reports by Silverman et al reporting that hypothermia was associated with increased mortality in preterm infants, neonatologists have tried to effectively regulate body temperature. The challenge that remains is that the smallest and most premature infants continue to have hypothermia on admission to the neonatal intensive care unit. In this volume of The Journal, Wilson et al report that hypothermia occurred in 53.4% of 5697 infants born at <32 weeks gestational age in a population-based study with samples from 11 European countries. More concerning is that 12.9% of the population had admission temperatures below 35.5°C. Thus, despite the recent focus on developing and testing new approaches to better maintain body temperature in this very high risk population, temperatures often were quite low soon after birth. In this large population, a low initial temperature was associated with increased death at 1 to 6 days and 7 to 28 days of age despite multiple adjustments for variables likely linked to low body temperature. Because later deaths with hypothermia were not associated with low Apgar scores or other complications of prematurity, the effect of admission temperature may not be explained by an association of low body temperature with a less favorable clinical status at birth. The causal link between hypothermia and mortality remains unexplained, but hypothermia following very preterm delivery is a preventable “disease” that requires constant attention to prevent. Article page 61▶ Admission Hypothermia in Very Preterm Infants and Neonatal Mortality and MorbidityThe Journal of PediatricsVol. 175PreviewTo investigate the association between body temperature at admission to neonatal intensive care and in-hospital mortality in very preterm infants, stratified by postnatal age of death. Moreover, we assessed the association between admission temperature and neonatal morbidity. Full-Text PDF

Hypothermia is an independent predictor of short and intermediate term mortality in acute systolic heart failure: Insights from the ESCAPE trial

IntroductionAdmission hypothermia is associated with increased mortality in patients hospitalized with sepsis, trauma or stroke. We hypothesized that hypothermia on admission in patients with acute systolic heart failure (HF) would be associated with worse survival. MethodsUsing ESCAPE trial data, we compared patients hospitalized with acute systolic HF with admission temperature ≤35.5°C or >35.5°C. The study endpoints were 30-day and 6-month all-cause mortality. ResultsAmong the 398 patients (mean age 56years, 74% men) who had body temperature recorded on hospital admission, 23 had a temperature ≤35.5°C (hypothermia) and 375 patients had a temperature >35.5°C. By univariate comparison, hypothermic patients had a higher blood urea nitrogen (BUN) level (46.6versus 34.6mg/dL, P=0.04) and creatinine level (1.85 versus 1.49mg/dL, P=0.035) and higher frequency of malignancy (26.1% versus 6.1%, P=0.001). There was a significant correlation between admission temperature and body mass index (r=0.201, P<0.0001). Patients with temperature≤35.5°C had a higher 30-day (17.4% versus 4.3%, univariate OR 4.724, 95% CI 1.439–15.509, P=0.01) and 6-month (43.5% versus 18.1%, univariate OR 3.473, 95% CI 1.462–8.25, P=0.005) all-cause mortality. Cox proportional hazard analysis revealed that admission temperature ≤35.5°C is an independent predictor of mortality (hazard ratio 2.222, 95% CI 1.117–4.420, P=0.023). Kaplan–Meier analysis comparing survival in patients with admission temperature ≤35.5°C or >35.5°C showed a significant inter-group difference in survival (log-rank P value=0.001). ConclusionAdmission body temperature ≤35.5°C is an independent predictor of short and intermediate term mortality in patients hospitalized with acute systolic HF.

Ventilation of Preterm Infants during Delayed Cord Clamping (VentFirst): A Pilot Study of Feasibility and Safety.

Background Establishing lung inflation prior to umbilical cord clamping may improve the cardiovascular transition and reduce the risk of intraventricular hemorrhage in preterm infants. We developed a pilot feasibility and safety study in which infants < 33 weeks' gestation received assisted ventilation during delayed cord clamping (DCC). Methods Infants born between 24 0/7 and 32 6/7 weeks' gestation whose mothers consented were enrolled. All infants received continuous positive airway pressure or positive pressure ventilation during 90 seconds of DCC. Outcomes included feasibility (ability to complete protocol and maintain a sterile field during cesarean deliveries) and safety variables (Apgar scores, umbilical cord pH and base deficit, admission temperature, and postcesarean infection). Results A total of 29 infants were enrolled, including one set of twins (median gestation: 30 weeks; 72% cesarean births). In all cases, the protocol was completed. Heart rate at 60 seconds was more than 100 beats per minute in all infants. Apgar scores, cord blood gas values, and admission temperature were comparable to other preterm deliveries at our institution. Conclusion Assisting ventilation of very preterm infants during 90 seconds of DCC is challenging but feasible and appears to be safe in this small pilot study. A randomized clinical trial is warranted to determine clinical benefit.

Admission Hypothermia in Very Preterm Infants and Neonatal Mortality and Morbidity

To investigate the association between body temperature at admission to neonatal intensive care and in-hospital mortality in very preterm infants, stratified by postnatal age of death. Moreover, we assessed the association between admission temperature and neonatal morbidity. In this cohort study from 19 regions in 11 European countries, we measured body temperature at admission for infants admitted for neonatal care after very preterm birth (<32weeks of gestation; n=5697) who were followed to discharge or death. Associations between body temperature at admission and in-hospital mortality and neonatal morbidity were analyzed by the use of mixed effects generalized linear models. The final model adjusted for pregnancy complications, singleton or multiple pregnancy, antenatal corticosteroids, mode of delivery, gestational age, infant size and sex, and Apgar score <7 at 5minutes. A total of 53.4% of the cohort had a body temperature at admission less than 36.5°C, and 12.9% below 35.5°C. In the adjusted model, an admission temperature <35.5°C was associated with increased mortality at postnatal ages 1-6days, (risk ratio 2.41; 95% CI 1.45-4.00), and 7-28days (risk ratio 1.79; 1.15-2.78) but not after 28days of age. We found no associations between admission temperature and neonatal morbidity. Admission hypothermia after very preterm birth is a significant problem in Europe, associated with an increased risk of early and late neonatal death.

Optimization of a Sensible Thermal Storage System by a Lumped Approach

This study is focused on the optimization of a sensible thermal storage system subjected to a cyclic energy source. The objective is to minimize the system heat storage mass and its geometry to guarantee its operation within an admissible temperature range. The storage medium is modeled as a Lumped system and the working fluid by a non-capacitive energy balance. The storage medium is composed of an array of parallel flat plates submitted to an air stream. The optimization is based on an exhaustive search method. It is observed that the minimum heat storage mass is proportional to the mass airflow rate. An optimal relationship between the superficial heat transfer rate and the fluid flow inertia, given by the dimensionless parameter NTU, is found to be constant (4.03) and independent in respect to the mass flow rate. The system time constant was invariable (3,230 s) for the optimal relationship between the interface heat transfer rate and the system inertia.

The Aetiologies and Impact of Fever in Pregnant Inpatients in Vientiane, Laos.

IntroductionLaos has the highest maternal mortality ratio in mainland Southeast Asia and a high incidence of infectious diseases. Globally, malaria has been the pathogen most intensively investigated in relation to impact on pregnancy, but there has been relatively little research on the aetiology and impact of other diseases. We therefore aimed to determine the causes and impact of fever in pregnant women admitted to two central hospitals in Vientiane City, Lao PDR (Laos).Materials and MethodsThis hospital-based prospective study was conducted in Mahosot Hospital and the Mother and Child Hospital, Vientiane, between 2006 and 2010, with the aim to recruit 250 consenting pregnant women admitted with tympanic temperature ≥37.5°C. Primary outcome was the cause of fever and secondary outcomes were pregnancy outcomes. Specific investigations (culture, antigen, molecular and serological tests) were performed to investigate causes of fever. After discharge, all pregnant women were asked to return for review and convalescence serum on day 10–14 and were monitored until delivery.Principle findings250 pregnant women were recruited to this study between February 2006 and November 2010. Fifty percent were pregnant for the first time. Their median (range) gestational age on admission was 24 (4–43) weeks. The median (range) tympanic admission temperature was 38.5°C (37.5–40.5°C). Fifteen percent of patients stated that they had taken antibiotics before admission. Headache, myalgia, back pain and arthralgia were described by >60% of patients and 149 (60%) were given a laboratory diagnosis. Of those with confirmed diagnoses, 132 (53%) had a single disease and 17 (7%) had apparent mixed diseases. Among those who had a single disease, dengue fever was the most common diagnosis, followed by pyelonephritis, scrub typhus, murine typhus and typhoid. Patients were also diagnosed with tuberculosis, appendicitis, Staphylococcus aureus septicemia, leptospirosis, Japanese encephalitis virus infection and Plasmodium falciparum malaria. Severe consequences, including maternal death, miscarriage, stillbirth, low birth weight and preterm birth, were found among 28 (78%) mothers with dengue fever, rickettsioses and typhoid.ConclusionFevers other than malaria, such as dengue, pyelonephritis, rickettsioses and typhoid are common causes of fever during pregnancy in the Asian tropics. Further investigations of their impact in the community on maternal death, fetal loss, vertical transmission, low birth weight and preterm birth are needed.

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign.

Despite advances in neonatal medicine, infants requiring neonatal intensive care continue to experience substantial morbidity and mortality. The purpose of this initiative was to generate large-scale simultaneous improvements in multiple domains of care in a large neonatal network through a program called the "100,000 Babies Campaign." Key drivers of neonatal morbidity and mortality were identified. A system for retrospective morbidity and mortality review was used to identify problem areas for project prioritization. NICU system analysis and staff surveys were used to facilitate reengineering of NICU systems in 5 key driver areas. Electronic health record-based automated data collection and reporting were used. A quality improvement infrastructure using the Kotter organizational change model was developed to support the program. From 2007 to 2013, data on 422 877 infants, including a subset with birth weight of 501 to 1500 g (n = 58 555) were analyzed. Key driver processes (human milk feeding, medication use, ventilator days, admission temperature) all improved (P < .0001). Mortality, necrotizing enterocolitis, retinopathy of prematurity, bacteremia after 3 days of life, and catheter-associated infection decreased. Survival without significant morbidity (necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, oxygen use at 36 weeks' gestation) improved. Implementation of a multifaceted quality improvement program that incorporated organizational change theory and automated electronic health record-based data collection and reporting program resulted in major simultaneous improvements in key neonatal processes and outcomes.

Effects of prehospital hypothermia on transfusion requirements and outcomes: a retrospective observatory trial

ObjectivesPrehospital hypothermia is defined as a core temperature <36.0°C and has been shown to be an independent risk factor for early death in patients with trauma. In a retrospective study,...

Icy Infants Quality Improvement Project: Improving Admission Temperatures in Very Low Birth Weight Infants

Icy Infants Quality Improvement Project: Improving Admission Temperatures in Very Low Birth Weight Infants

Stabilisation of premature infants in the delivery room with nasal high flow

ObjectiveThis was a pilot study to determine the feasibility of using nasal high flow (nHF) (also known as heated humidified high-flow nasal cannula) for stabilisation of babies born at <30...

Исследование условий максимального использования тепла химических реакций при сульфатизирующем обжиге чернового медного сульфидного концентрата

The paper describes the results of multifactorial experiments of roughing granulated copper sulphide concentrates on the influence of the sulfur content in the concentrate, specified air temperature, the granule size, the air flow on the study of conditions of the maximum use of the chemical reactions heat in the sulphatization roasting process. Mathematical models are received, which are used to determine the roasting optimal area from the point of view of getting into the zone under the terms of allowable temperature to avoid sintering material as well as the terms of preservation of the sulfates image. It is found that not exceeding admissible calcining temperature can be achieved even if the sulfur content is greater than 10 % due to the temperature decrease and the use of larger granules. But at an air temperature of 500 °C the optimum temperature is exceeded at any circumstances. The apparent activation energy calculated from the DTA data amounted to 27.714 kJ/mol and shows that the process is controlled by internal diffusion of gaseous reactants through the bed of formed sulfates.

Reducing Transitional Hypothermia in Outborn Very Low Birth Weight Infants

Background: Transitional hypothermia (TH) is associated with increased morbidity and mortality in very low birth weight (VLBW) infants worldwide. Objectives: To assess the effect of a quality improvement project (QIP) on outborn TH and the associated mortality/morbidity among VLBW neonates. Methods: We conducted a multi-intervention QIP to reduce TH (<36°C) among outborn VLBW neonates. This cohort study compared a historical group (group I, n = 86) to a prospective group (group II, established after QIP implementation, n = 86). The primary outcome was axillary temperature measured in the delivery room (DR) and upon admission to the neonatal intensive care unit (NICU). Results: The baseline characteristics of the two groups were similar. After introducing the QIP, the mean DR and NICU admission temperatures of the patients rose from 35.5 to 36.1°C and from 34.6 to 36.2°C, respectively (p < 0.01), and the percentage of patients with temperatures <36°C in the DR and NICU decreased from 80 to 40% and from 81 to 42% (p < 0.01), respectively. Meanwhile, the percentage of patients with a normal temperature in the DR and NICU rose from 20 to 58% and from 19 to 56% (p < 0.01), respectively, which was accompanied by significantly decreased mortality (p < 0.02) and other improvements. Conclusion: Implementation of a QIP resulted in a decrease in the number of moderately hypothermic VLBW neonates and a sustained improvement in normothermia rates during DR stabilization and transfer to the NICU in outborn VLBW neonates.

Utility valuations of health states after traumatic brain injury: preliminary results

METHODS: We did a 2 year (2011-2012) analysis of National Trauma Data Bank.We included all patients with isolated severe TBI (head AIS 3 and other body AIS<3). Patients were divided into two groups: Hypothermic (admission temperature <35 C) and Normothermic (admission temperature 35 C).Our outcome measures were mortality, hospital, and ICU length of stay.We performed missing values analysis and multiple imputation technique to account for missing data. Propensity score matching was performed adjusting for age, gender, race, insurance status, h-AIS, ISS, systolic blood pressure, heart rate, and oxygen saturation.

Is there an association between body temperature and serum lactate levels in hip fracture patients?

Introduction Hyperlactataemia is associated with adverse outcomes in trauma cases. It is thought to be the result of anaerobic respiration during hypoperfusion. This produces much less energy than complete aerobic glycolysis. Low body temperature in the injured patient carries an equally poor prognosis. Significant amounts of energy are expended in maintaining euthermia. Consequently, there may be a link between lactate levels and dysthermia. Hyperlactataemia may be indicative of inefficient energy production and therefore insufficient energy to maintain euthermia. Alternatively, significant amounts of available oxygen may be sequestered in thermoregulation, resulting in anaerobic respiration and lactate production. Our study investigated whether there is an association between lactate levels and admission body temperature in hip fracture patients. Furthermore, it looked at whether there is a difference in the mean lactate levels between hip fracture patients with low (<36.5°C), normal (36.5-37.5°C) and high (>37.5°C) body temperature on admission, and for patients who have low body temperature, whether there is a progressive rise in serum lactate levels as body temperature falls. Methods The admission temperature and serum lactate of 1,162 patients presenting with hip fracture were recorded. Patients were divided into the euthermic (body temperature 36.5-37.5°C), the pyrexial (>37.5°C) and those with low body temperature (<36.5°C). Admission lactate and body temperature were compared. Results There was a significant difference in age between the three body temperature groups (p=0.007). The pyrexial cohort was younger than the low body temperature group (mean: 78 vs 82 years). Those with low body temperature had a higher mean lactate level than the euthermic (2.2mmol/l vs 2.0mmol/l, p=0.03). However, there was no progressive rise in serum lactate level as admission temperature fell. Conclusions The findings suggest that in hip fracture patients, the body attempts initially to maintain euthermia, incurring an oxygen debt. This would explain the difference in lactate level between the low body temperature and euthermic cohorts. The fact that there is no correlation with the degree of temperature depression and lactate levels indicates that the body does not fuel thermohomeostasis indefinitely with oxygen. Instead, in part, it abandons thermoregulatory mechanisms. Consequently, in this population, active rewarming may be indicated rather than depending on patients' own thermogenic ability.

Effect of delayed cord clamping on very preterm infants

Despite significant proposed benefits, delayed umbilical cord clamping (DCC) is not practiced widely in preterm infants largely because of the question of feasibility of the procedure and uncertainty regarding the magnitude of the reported benefits, especially intraventricular hemorrhage (IVH) vs the adverse consequences of delaying the neonatal resuscitation. The objective of this study was to determine whether implementation of the protocol-driven DCC process in our institution would reduce the incidence of IVH in very preterm infants without adverse consequences. We implemented a quality improvement process for DCC the started in August 2013 in infants born at ≤32 weeks' gestational age. Eligible infants were left attached to the placenta for 45 seconds after birth. Neonatal process and outcome data were collected until discharge. We compared infants who received DCC who were born between August 2013 and August 2014 with a historic cohort of infants who were born between August 2012 and August 2013, who were eligible to receive DCC, but whose cord was clamped immediately after birth, because they were born before the protocol implementation. DCC was performed on all the 60 eligible infants; 88 infants were identified as historic control subjects. Gestational age, birthweight, and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in the DCC cohort were intubated in delivery room, had respiratory distress syndrome, or received red blood cell transfusions in the first week of life compared with the historic cohort. A significant reduction was noted in the incidence of IVH in the DCC cohort compared with the historic control group (18.3% vs 35.2%). After adjustment for gestational age, an association was found between the incidence of IVH and DCC with IVH was significantly lower in the DCC cohort compared with the historic cohort; an odds ratio of 0.36 (95% confidence interval, 0.15-0.84; P < .05). There were no significant differences in deaths and other major morbidities. DCC, as performed in our institution, was associated with significant reduction in IVH and early red blood cell transfusions. DCC in very preterm infants appears to be safe, feasible, and effective with no adverse consequences.