Hypothermia In Preterm Infants Research Articles

Knowledge and practices of neonatal intensive care unit nurses concerning hypothermia in preterm infants: Adescriptive cross-sectional study.

To investigate the knowledge level and clinical practice of neonatal intensive care unit nurses on the whole process of hypothermia prevention in preterm infants. A polycentric descriptive cross-sectional study was conducted in 23 hospitals in Shandong province involving 254 neonatal intensive care unit nurses. An evidence-based knowledge and clinical practice questionnaire on hypothermia prevention in preterm infants and a general information questionnaire were used to collect data. SPSS and EXCEL 24.0 database were used for data statistics and analysis. Nearly one-third of nurses were unclear about the definition of mild hypothermia and heat preservation measures during labour management and resuscitation. Knowledge about the correct rate of amniotic fluid evaporation was low. The higher the hospital level and nurses' education level, professional title, work experience, and position, the higher the knowledge level. The clinical practice of nurses differed in terms of body temperature assessment tools, measurement sites, and measurement frequency for premature infants. Nurses in neonatal intensive care units need to apply evidence-based knowledge and carry out practice interventions to ensure preterm infants' safe transition from the delivery room to the neonatal intensive care unit. There have been few studies evaluating neonatal nurses' knowledge and practices with regards to the preventing hypothermia of premature infants from delivery room to neonatal intensive care unit. The study identifies the deficiencies and problems in temperature management that can be attributed to the knowledge level of nurses. The findings will help improve the current curriculum, teaching strategies, and the nurses' knowledge levels, preventing premature hypothermia in infants. This study adhered to the STROBE statement for observational studies and obtained approval (KYLL-2023LW045) from the ethics committee of The Second Hospital of Shandong University. The other 22 third- and second-level hospitals, as our alliance members, recognized our chairperson status within the alliance and were willing to join our academic activities. Mutual responsibility for ethical filing between alliance units. 254 nurses were recruited from 23 tertiary and secondary public hospitals in Shandong province. No public or patient involvement. Members of the research group used the Questionnaire Star platform to prepare the electronic questionnaire, including obtaining informed consent, taking precautions for questionnaire completion, and using the aforementioned measurement tools. The project research team contacted the head nurses of 23 neonatal intensive care units in Shandong Province. After obtaining consent from the head nurses, they were asked to send the requirements and link of the electronic questionnaire to their WeChat management group. The nurses go through each question and make a choice which has two options of 'agree' or 'disagree.' Based on their answers, nurses were evaluated as having 'mastered' or 'not mastered' each item. Each 'mastered' item (correct answer) was given a score of 4; an item 'not mastered' (incorrect answer) was given a score of 0. The total score ranged from 0 to 100.

Hypothermia in preterm infants admitted to low-resource neonatal units in northern Nigeria: an observational study of occurrence and risk factors

BackgroundHypothermia is an important cause of morbidity and mortality among preterm and low-birth-weight neonates. In resource-constrained settings, limited referral infrastructure and technologies for temperature control potentiate preterm hypothermia. While there is some documentation on point-of-admission hypothermia from single center studies, there are limited multicenter studies on the occurrence of hypothermia among preterm infants in resource-limited-settings. Therefore, we conducted a multicenter study to determine the prevalence and risk factors for hypothermia at the time of admission and during the first 72 h after admission in northern Nigeria.MethodWe carried out a prospective cohort study on preterm infants admitted to four referral hospitals in northern Nigerian between August 2020 and July 2021. We documented temperature measurements at admission and the lowest and highest temperatures in the first 72 h after admission. We also collected individual baby-level data on sociodemographic and perinatal history data. We used the World Health Organization classification of hypothermia to classify the babies’ temperatures into mild, moderate, and severe hypothermia. Poisson regression analysis was used to identify risk factors for moderate-severe hypothermia.ResultsOf the 933 preterm infants enrolled, 682 (72.9%) had hypothermia at admission although the prevalence of hypothermia varied across the four hospitals. During the first 24 h after admission, 7 out of every 10 babies developed hypothermia. By 72 h after admission, between 10 and 40% of preterm infants across the 4 hospitals had at least one episode of moderate hypothermia. Gestational age (OR = 0.86; CI = 0.82–0.91), birth weight (OR = 8.11; CI = 2.87–22.91), presence of a skilled birth attendant at delivery (OR = 0.53; CI = 0.29–0.95), place of delivery (OR = 1.94 CI = 1.13–3.33) and resuscitation at birth (OR = 1.79; CI = 1.27–2.53) were significant risk factors associated with hypothermia.ConclusionThe prevalence of admission hypothermia in preterm infants is high and hypothermia is associated with low-birth-weight, place of delivery and presence of skilled birth attendant. The prevalence of hypothermia while in care is also high and this has important implications for patient safety and quality of patient care. Referral services for preterm infants need to be developed while hospitals need to be better equipped to maintain the temperatures of admitted small and sick newborns.

Association of hypermagnesemia at birth and admission hypothermia in pre-term infants: A secondary analysis of a prospective cohort study.

Hypothermia on admission is associated with increased mortality in preterm infants. Drugs administered to pregnant women is implicated in its occurrence. Since magnesium sulfate has a myorelaxant effect, we aimed evaluating the association of hypermagnesemia at birth and admission hypothermia (axillary temperature <36.5°C) in preterm infants. We performed a secondary analysis of a prospective cohort study database including inborn infants <34 weeks, without congenital malformations. Hypermagnesemia was considered if the umbilical magnesium level > 2.5 mEq/L. Maternal and neonatal variables were used to adjust the model, submitted to the multivariate hierarchical modelling process. We evaluated 249 newborns with median birth weight and gestational age of 1375 (IQR 1020-1375) g and 31 (IQR 28-32) weeks, respectively. Hypermagnesemia occurred in 28.5% and admission hypothermia occurred in 28.9%. In the univariate analysis, the following variables were identified as being associated with admission hypothermia: hypermagnesemia (OR 3.71; CI 2.06-6.68), resuscitation (OR 2.39; CI 1.37-4.19), small to gestational age (OR 1.91; CI1.03-3.53), general anesthesia (OR 3.34; CI 1.37-8.13), birth weight (OR 0.998; CI 0.998-0.999) and gestational age (OR 0.806; CI 0.725-0.895). In the hierarchical regression model, hypermagnesemia remained independent associated with admission hypothermia (OR 3.20; CI 1.66-6.15), as well as birth weight (OR 0.999; CI 0.998-0.999) and tracheal intubation (3.83; CI 1.88-7.80). Hypermagnesemia was associated with an increased risk of admission hypothermia, as did tracheal intubation and lower birth weight.

Frequency of Neonatal Hypothermia in Preterm Infants Wrapped with and without Plastic Bag after delivery

Background: Preterm birth accompanies many complications including hypothermia that worsens neonatal health and may result in fatality if left untreated. Globally, plastic wraps are being used as a low-cost and effective method to maintain temperature. Aim: To compare frequency of neonatal hypothermia in preterm infants wrapped with and without plastic bag after delivery. Study design: This was randomized control trial. Methodology: This study was conducted using at Pediatrics department of SIMS hospital, Lahore, during 6 months. Data was collected using non-probability, consecutive sampling from a sample of 92 (46 newborns in each group). Infants randomized to group-B (no bag group) received standard hospital care based on WHO thermoregulation of the newborn protocol. The data was entered and analyzed in SPSS 23. Results: In plastic wrap group there were 32(69.57%) male and 14(30.43%) female cases while in no wrap group there were 27(58.70%) male and 19(41.30%) female cases, p-value &gt;0.05. The median temperature after one hour was higher in plastic wrap and no wrap group was 37.6±0.7 and 36.85±1.80c respectively, p-value &lt; 0.05. There were 3(6.5%) cases in plastic wrap group and 15(32.6%) of the cases in no wrap group who developed hypothermia, the frequency of hypothermia was statistically less in wrap group when compared with no wrap group, p-value &lt;0.05. Practical Implication: However, there is limited literature in Pakistan that compares temperature maintenance among neonates wrapped and unwrapped with plastic bags. This investigation will help find better answers to this problem. Conclusion: It is concluded that the preterm infants wrapped with plastic bag after delivery had less frequency of neonatal hypothermia after 1 hour. Plastic wraps are effective, low cost and low resource friendly method that should be opted for temperature maintenance of preterm babies. Keywords: Hypothermia, Preterm Birth, Hyperthermia, plastic wraps, Neonates and Temperature.

Quality improvement bundles to decrease hypothermia in very low/extremely low birth weight infants at birth: a systematic review and meta-analysis.

Numerous studies have demonstrated that hypothermia in preterm infants correlates with increased morbidity and mortality, especially among those with very low or extremely low birth weights (VLBW/ELBW). An increasing number of healthcare facilities are implementing quality improvement (QI) bundles to lower the incidence of hypothermia at birth in this vulnerable population. However, the effectiveness and safety of these interventions have yet to be fully assessed. A meta-analysis is necessary to evaluate the efficacy and safety of QI bundles in reducing hypothermia at birth among VLBW/ELBW infants. We searched PubMed, Embase, the Cochrane Library and Web of Science through April 22nd, 2024. Study selection, data extraction, quality evaluation and risk bias assessment were performed independently by two investigators. Meta-analysis was performed using Review Manager 5.4.1. A total of 18 studies were included for qualitative analysis and 12 for meta-analysis. For VLBW infants, meta-analysis revealed a reduction in hypothermia and an increase in hyperthermia following the introduction of QI bundles (mild hypothermia, OR 0.22, 95% CI [0.13-0.37]; moderate hypothermia, OR 0.18, 95% CI [0.15-0.22]; hyperthermia, OR 2.79, 95% CI [1.53-5.09]). For ELBW infants, meta-analysis showed a decrease in hypothermia but no increase in hyperthermia after implementing QI bundles (mild hypothermia, OR 0.46, 95% CI [0.26-0.81]; moderate hypothermia, OR 0.21, 95% CI [0.08-0.58]; hyperthermia, OR 1.10, 95% CI [0.22-5.43]). QI bundles effectively reduce hypothermia in VLBW/ELBW infants, but they may also increase hyperthermia, especially in VLBW infants.

Evaluation of two polyethylene bags in preventing admission hypothermia in preterm infants: a quasi-randomized clinical trial

ObjectiveTo compare two polyethylene bags in preventing admission hypothermia in preterm infants born at <34 weeks gestation. MethodQuasi-randomized unblinded clinical trial conducted at a level III neonatal unit between June 2018 to September 2019. The authors assign infants between 240/7 and 336/7 weeks’ gestation to receive NeoHelp™ bag (intervention group) or a usual plastic bag (control group). The primary outcome was admission hypothermia, considering an axillary temperature at admission to the neonatal unit of <36.0 °C. Hyperthermia was considered if the admission temperature reached 37.5 °C or more. ResultsThe authors evaluated 171 preterm infants (76, intervention group; 95, control group). The rate of admission hypothermia was significantly lower in the intervention group (2.6% vs. 14.7%, p = 0.007), with an 86% reduction in the admission hypothermia rate (OR, 0.14; 95% CI, 0.03–0.64), particularly for infants weighing >1000 g and >28 weeks gestation. The intervention group also had a higher median of temperature at admission – 36.8 °C (interquartile range 36.5–37.1) vs. 36.5 °C (interquartile range 36.1–36.9 °C), p = 0.001, and showed a higher hyperthermia rate (9.2% vs. 1.0%, p = 0.023). Birth weight was also associated to the outcome, and it represented a 30% chance reduction for every 100-g increase (OR, 0.997; 95% CI, 0.996–0.999). The in-hospital mortality rate was similar between groups. ConclusionThe intervention polyethylene bag was more effective in preventing admission hypothermia. Nonetheless, the risk of hyperthermia is a concern during its use.

Hypothermia among premature newborns on admission to a neonatal intensive care unit.

To assess prevalence and factors associated with hypothermia in preterm infants admitted to a neonatal intensive care unit. It is a cross-sectional retrospective study, with 154 premature newborns admitted between 2017 and 2019 in a neonatal intensive care unit. Logistic regression was used to evaluate the association to hypothermia. There was a predominance of males (55.8%), coming from the operating room (55.8%), gestational age > 32 weeks (71.4%), weight > 1500g (59.1%), Apgar in the 1st minute of life less than seven (51.9%) and in the 5th minute of life greater than or equal to seven (94.2%). The prevalence of hypothermia at admission was 68.2%. It was found that the lower the weight, the greater the chances of hypothermia, being three times higher in low weight (OR 3.480), five times higher in very low weight (OR5.845) and up to 47 times higher in extremely low weight (OR47.211). Hypothermia was 68.2% and it was associated with lower birth weight.

Reducing intraventricular hemorrhage following the implementation of a prevention bundle for neonatal hypothermia.

In very low birth weight (VLBW) infants, hypothermia immediately following birth is common even in countries rich in medical resources. The purpose of this study is to design a standard prevention bundle that decreases the rate of hypothermia among infants after birth and to investigate efficacy of the bundle and short-term outcomes for VLBW infants. This quality improvement project was conducted from February 2017 to July 2018 on all VLBW preterm infants admitted at a single referral level III neonatal intensive care unit. The infants were classified into the pre-intervention (February to September 2017) and post-intervention (October 2017 to July 2018) groups according to the time periods when they were recruited. During the pre-intervention period, we analyzed the primary causes of hypothermia, developed solutions corresponding to each cause, integrated all solutions into a prevention bundle, and applied the bundle during the post-intervention period. Afterwards, the incidence of neonatal hypothermia and short-term outcomes, such as intraventricular hemorrhage (IVH), acidosis, and shock requiring inotropic agents, in each group were compared. A total of 95 VLBW infants were enrolled in the study, including 37 pre-intervention, and 58 post-intervention cases. The incidence of hypothermia in preterm infants decreased significantly upon the implementation of our prevention bundle, both in the delivery room (from 45.9% to 8.6%) and on admission (59.5% to 15.5%). In addition, the short-term outcomes of VLBW infants improved significantly, especially with the decreased incidence of IVH (from 21.6% to 5.2%, P = 0.015). Our standardized prevention bundle for preventing hypothermia in VLBW infants is effective and decreased the IVH rate in VLBW infants. We strongly believe that this prevention bundle is a simple, low-cost, replicable, and effective tool that hospitals can adopt to improve VLBW infant outcomes.

Improvement in thermoregulation outcomes following the implementation of a thermoregulation bundle for preterm infants.

AimHypothermia is associated with increased morbidity and mortality in preterm infants. A local audit revealed 60% preterm infants ≤32 weeks gestation and/or very low birth weight (VLBW) infants (<1500 g) had an abnormal body temperature at admission. This study compares thermoregulatory outcomes before and after the implementation of a thermoregulation bundle in the birthing environment.MethodsThis retrospective cohort study reviewed thermoregulatory data for all inborn preterm (≤32 weeks) and/or VLBW infants for a period of 30 months before (Group 1: 1st January 2013 to 30 June 2015) and after changes to thermoregulation practice (Group 2: 1st July 2015 to 31 December 2017). The key practice changes included: improved anticipation and staff preparedness, wrapping infant in a polyethylene sheet, using a polyethylene lined bonnet, using servo‐control mode at birth and during transport.ResultsThere were 282 and 286 infants in group 1 and group 2 respectively, with similar baseline characteristics. A clinically and statistically significant improvement was observed in the proportion of infants with normothermia (33% in group 1 to 60% in group 2, P < 0.0001) including the sub‐group of extremely preterm (<28 weeks gestation) infants (38 to 60%, P = 0.0083). A higher mean admission temperature was observed for group 2 (36.10°C ± 0.78 in group 1 vs 36.52°C ± 0.61 in group 2, P < 0.0001). Moderate hypothermia was reduced by two‐thirds in group 2 (41–12%, P = <0.0001).ConclusionsThe introduction of a thermoregulation bundle improved admission temperature, improved the proportion of normothermia and reduced moderate hypothermia in preterm infants.

Association between hypothermia in the first day of life and survival in the preterm infant

ObjectiveHypothermia is associated with elevated mortality in the preterm infant. The preterm infant's thermoregulatory capacity is limited, and the thermal environment in an incubator is often perturbed by nursing procedures. We evaluated the incidence of a postnatal low body temperature and hypothermia in preterm infants and its association with mortality. MethodsWe measured the lowest body temperature during the first 24h of life (TBody Nadir 24h) and hypothermia (TBody Nadir 24h<36.0°C) in preterm infants (gestational age: 230–316 weeks) in a neonatal intensive care unit. Prenatal and neonatal characteristics associated with mortality were identified in univariate and multivariable analyses. ResultsA total of 102 preterm infants were included, with a mean gestational age at birth of 28.4±2.3 weeks. The incidence of hypothermia during the first 24h was 53%. A Cox multivariate regression model indicated that TBody Nadir 24h (hazard ratio (HR) [95% confidence interval]: 0.57 [0.36–0.90]; P=0.017), gestational age (0.62 [0.50–0.76]; P<0.001), and amine use (4.55 [2.01–10.28]; P=0.001) were significantly associated with mortality. When considering a threshold for TBody Nadir 24h, a value of 35.0°C had the highest HR (3.30 [1.42–7.68]; P<0.01). ConclusionIn preterm infants, the incidence of hypothermia during the first 24h of life was 53%. TBody Nadir 24h had an influence on mortality, independently of other factors (notably birth weight and amine use). Within the framework of a quality improvement strategy, the implementation of a thermoregulation bundle is required to prevent hypothermia and decrease mortality in preterm infants.

Improving survival of preterm babies in low- to middle-income countries – what can we do?

Surviving prematurity poses the greatest challenge in neonatal care in low- to middle-income countries (LMICs). South Africa has not made much progress in improving the survival of preterm babies. Neonatal survival of preterm infants has become a national priority since the serious failure to reach the Millennium Development Goal targets in 2015. High rates of prevention are particularly relevant in LMICs, where the neonatal mortality rate is at its highest owing to a lack of simple and effective measures. Preventing prematurity and related complications begins with a healthy pregnancy. Antenatal care and maternal corticosteroids are antenatal interventions that could improve the survival of preterm babies. Postnatal interventions include: the management of neonatal sepsis, meningitis and pneumonia; prevention of hypothermia after delivery, for example, the plastic bag/wrap and cap, which has been extensively researched and is found to be an effective, low-cost method for reducing hypothermia in preterm infants; the use of continuous positive airway pressure (CPAP), including the low-cost CPAP device, which is a cost-effective strategy for providing respiratory support for premature neonates with respiratory distress syndrome; exogenous surfactant; early feeding with breastmilk; and kangaroo mother care. The use of cost-effective, evidence-based interventions can be implemented in LMICs to reduce neonatal mortality

The impact of a quality improvement effort in reducing admission hypothermia in preterm infants following delivery.

Purpose Hypothermia at admission is associated with increased mortality and morbidity in preterm infants. We performed a quality improvement (QI) effort to determine the impact of a decrease in admission hypothermia in preterm infants.Methods The study enrolled very low birth weight (VLBW) infants born at Gangnam Severance Hospital between January 2013 and December 2016. This multidisciplinary QI effort included the use of occlusive wraps, warm blankets, and caps; the delivery room temperature was maintained above 23.0˚C, and a check-list was used for feedback.Results Among 259 preterm infants, the incidence of hypothermia (defined as body temperature <36.0˚C) decreased significantly from 68% to 41%, and the mean body temperature on neonatal intensive care unit admission increased significantly from 35.5˚C to 36.0˚C. In subgroup analysis of VLBW infants, admission hypothermia and neonatal outcomes were compared between the pre-QI (n=55) and post-QI groups (n=75). Body temperature on admission increased significantly from 35.4˚C to 35.9˚C and the number of infants with hypothermia decreased significantly from 71% to 45%. There were no cases of neonatal hyperthermia. The incidence of pulmonary hemorrhage was significantly decreased (P=0.017). Interaction analysis showed that birth weight and gestational age were not correlated with hypothermia following implementation of the protocol.Conclusion Our study demonstrated a significant reduction in admission hypothermia following the introduction of a standardized protocol in our QI effort. This resulted in an effective reduction in the incidence of massive pulmonary hemorrhage.

Efficacy and safety of the heated gel mattress for prevention of hypothermia in preterm infants during intra-hospital transport: a meta-analysis

Efficacy and safety of the heated gel mattress for prevention of hypothermia in preterm infants during intra-hospital transport: a meta-analysis

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

Thermoregulation: Advances in Preterm Infants

* Abbreviations: NTE: : neutral thermal environment T3: : thyroxine T4: : triiodothyronine 1. Thermoregulation of preterm infants is often overlooked, precipitating hypothermia. 2. Clinicians should understand the morbidities and the mortality associated with hypothermia in preterm infants. 3. Clinicians should be able to plan appropriate management to prevent hypothermia after birth and beyond. After completing this article, readers should be able to: 1. Describe the mechanisms of heat production and heat loss in neonates, and why preterm infants are more susceptible. 2. Identify the conditions leading to hypothermia in preterm infants and its consequences. 3. Recognize the different ways of preventing hypothermia in preterm neonates. Newborns must undergo many adaptations after delivery to adjust to extrauterine life. One of the paramount adjustments is the need to rapidly increase body temperature, and strive to accommodate to an environment colder than that of the prenatal milieu. The temperature of a fetus is 0.9°F (0.5°C) above the maternal temperature but within a few minutes after birth, the neonatal core temperature begins to fall. (1) Keeping newborns warm, especially preterm infants, can be challenging. Preterm infants can be characterized as inefficient homeotherms. Although they do have an initial appropriate response to a decrease in environmental temperatures, the effect is limited, placing the preterm infant at high risk for hypothermia with all of its associated complications. Budin (2) and Silverman, pioneers in the field of neonatology, had observed significant mortality among low-birthweight infants who were hypothermic on admission to the nursery and in the first few days after birth. (3) They noted a striking improvement in survival rates if infants were cared for in warm environments, especially in the first 5 days after birth. Budin found a significant difference in mortality based on the temperature of newborns at the time of admission to the NICU. In this study, the mortality rate in neonates weighing less than 2,000 g was as high as 98% …

A quality improvement project to reduce hypothermia in preterm infants on admission to the neonatal intensive care unit.

To study effectiveness of quality improvement interventions in reducing hypothermia in preterm infants on admission to neonatal intensive care unit. Quality improvement methodologies including multidisciplinary planning and implementation of evidence-based interventions. Data during and post-implementation were collected. In total, 84 preterm infants with birth weights ≤ 1500 g delivered during implementation period (October 2008-April 2009) were compared with 168 historical controls and 947 infants in the subsequent 4 years. In addition to routine interventions, delivery room temperatures were increased, and use of full-body polyethylene wraps and woollen caps were implemented during initial stabilization. Education and training were provided to reinforce the new interventions. Primary outcome was incidence of hypothermia and mean admission temperature. Secondary outcomes were rates of intraventricular haemorrhage and mortality. Incidence of admission hypothermia decreased from 79.4 to 40.5% (P < 0.001), constituting a 49% improvement (OR = 0.177, 95% CI: 0.099-0.316). Mean admission temperature increased from 35.8 ± 0.8°C to 36.5 ± 0.7°C (P < 0.001). Hyperthermia incidence was higher at 6% compared to baseline of 1.3% (P = 0.049). The incidence of admission hypothermia remained stable at 47.4% in the 4 years post-implementation. Rates of intraventricular haemorrhage and mortality remained unchanged. Small for gestation, low 5-min Apgar score and singleton delivery were factors found to be associated with admission hypothermia. The implementation of evidence-based best practices resulted in significant reduction in admission hypothermia in preterm infants, which persisted for 4 years post-implementation. The practices have since become standard of care in our institution.

Safety and Short-Term Outcomes of Therapeutic Hypothermia in Preterm Neonates 34-35 Weeks Gestational Age with Hypoxic-Ischemic Encephalopathy

To evaluate the safety and short-term outcomes of preterm neonates born at 34-35 weeks gestation with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia. Medical records of preterm neonates born at 34-35 weeks gestational age with HIE treated with therapeutic hypothermia were retrospectively reviewed. Short-term safety outcomes and the presence, severity (mild, moderate, severe), and patterns of brain injury on magnetic resonance imaging were reviewed using a standard scoring system, and compared with a cohort of term neonates with HIE treated with therapeutic hypothermia. Thirty-one preterm and 32 term neonates were identified. Therapeutic hypothermia-associated complications were seen in 90% of preterm infants and 81.3% of term infants (P = .30). In the preterm infants, hyperglycemia (58.1% vs31.3%, P = .03) and rewarming before completion of therapeutic hypothermia (19.4% vs 0.0%, P = .009) were more likely compared with term infants. All deaths occurred in the preterm group (12.9% vs 0%, P = .04). Neuroimaging showed the presence of injury in 80.6% of preterm infants and 59.4% of term infants (P = .07), with no differences in injury severity. Injury to the white matter was more prevalent in preterm infants compared with term infants (66.7% vs 25.0%, P = .001). Therapeutic hypothermia in infants born at 34-35 weeks gestational age appears feasible. Risks of mortality and side effects warrant caution with use of therapeutic hypothermia in preterm infants.

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

Efficacy and Safety of Plastic Wrap for Prevention of Hypothermia after Birth and during NICU in Preterm Infants: A Systematic Review and Meta-Analysis.

ObjectiveThis meta-analysis aimed to investigate the efficacy and safety of plastic wrap applied after birth and during NICU in preterm infants for prevention of heat loss in preterm infants.Study MethodsThe Medline (1950 to August 2015), the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 7, 2015), CINAHL (1982 to August 2015) and the Embase (1974 to August 2015) databases were searched for randomized controlled trials (RCTs) or quasi-RCTs with main outcomes related to the core temperature (baseline temperature and/or post-stabilization temperature), hypothermia, mortality rate and hyperthermia.ResultThe included studies were of low to moderate quality. Compared with unwrapped infants, plastic wrap was associated with a significantly higher baseline temperature and post-stabilization temperature both in infants < 28 weeks of gestation (mean difference [MD] = 0.62, 95% CI 0.38 to 0.85; MD = 0.41, 95% CI 0.33 to 0.50, respectively), and in infants between 28 to 34 weeks of gestation (MD = 0.54, 95% CI 0.21 to 0.87; MD = 0.64, 95% CI 0.45 to 0.82, respectively). Use of plastic wrap was associated with lower incidence of hypothermia (relative risk [RR] = 0.70, 95% CI 0.63 to 0.78). However, use of plastic wrap in preterm infants was not associated with decrease in mortality (RR: 0.88, 95% CI 0.70 to 1.12, P = 0.31). Incidence of hyperthermia was significantly higher in the plastic wrap group as compared to that in the control group (RR = 2.55, 95% CI: 1.56 to 4.15, P = 0.0002). Hyperthermia in the plastic wrap group was resolved within one or two hours after unwrapping the babies.ConclusionPlastic wrap can be considered an effective and safe additional intervention to prevent hypothermia in preterm infants. However, its cost-effectiveness and long-term effect on mortality needs to be ascertained by conducting well-designed studies with longer follow-up period.

Preventing Hypothermia in Preterm Infants: A Program of Research

Neonatal hypothermia is a worldwide problem and leads to increased morbidity and mortality in newborn infants. This paper describes a program of research to examine thermoregulation in premature infants and to decrease neonatal hypothermia. Our studies include 1) examining an intervention to reduce heat loss in premature infants by placing them in polyurethane bags after birth; 2) a descriptive study examining central and peripheral temperatures during the first 12 hours of age; 3) and a study examining central and peripheral temperatures over premature infants’ first two weeks of life. Currently we are using an esophageal tube with an imbedded thermistor (Philips Healthcare) to display continuous central temperature in a randomized controlled trial to see if this intervention will lead to warmer temperatures during the stabilization period than monitoring temperatures intermittently using axillary temperatures and skin probes. Future research will include expanding collaborative studies into low to moderate resource countries to help reduce infant hypothermia and infant mortality.Keywords: neonatal hypothermia, thermoregulation, infant body temperature regulation