Paediatrics Publications

Title

Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33weeks' gestation

Authors

Yanyu Lyu, Mount Sinai Hospital of University of Toronto
Prakesh S. Shah, Mount Sinai Hospital of University of Toronto
Xiang Y. Ye, Mount Sinai Hospital of University of Toronto
Ruth Warre, Mount Sinai Hospital of University of Toronto
Bruno Piedboeuf, CHU de Québec - Université Laval
Akhil Deshpandey, Janeway Children's Health and Rehabilitation Centre
Michael Dunn, University of Toronto
Shoo K. Lee, Mount Sinai Hospital of University of Toronto
Adele Harrison, Victoria General Hospital
Anne Synnes, BC​ Children​'​​s Hospital
Todd Sokoran, Royal Columbian Hospital, New Westminster
Wendy Yee, Foothills Medical Centre
Khalid Aziz, Royal Alexandra Hospital, Edmonton
Zarin Kalapesi, Regina General Hospital
Koravangattu Sankaran, Royal University Hospital
Mary Seshia, Health Sciences Centre Winnipeg
Ruben Alvaro, Hôpital St-Boniface
Sandesh Shivananda, Hamilton Health Sciences
Orlando Da Silva, London Health Sciences CentreFollow
Chuks Nwaesei, Windsor Regional Hospital
Kyong Soon Lee, Hospital for Sick Children University of Toronto
Michal Dunn, Sunnybrook Health Sciences Centre
Nicole Rouvinez-Bouali, Children's Hospital of Eastern Ontario, Ottawa
Kimberly Dow, Kingston General Hospital, Ontario
Ermelinda Pelausa, Sir Mortimer B. Davis Jewish General Hospital
Keith Barrington, CHU Sainte-Justine - Le Centre Hospitalier Universitaire Mère-Enfant
Christine Drolet, CHU de Québec - Université Laval
Patricia Riley, Centre Universitaire de Santé McGill, Hôpital de Montreal Pour Enfants
Valerie Bertelle, Centre Hospitalier Universitaire de Sherbrooke

Document Type

Article

Publication Date

4-1-2015

Journal

JAMA Pediatrics

Volume

169

Issue

4

URL with Digital Object Identifier

10.1001/jamapediatrics.2015.0277

Abstract

Importance: Neonatal hypothermia has been associated with higher mortality and morbidity; therefore, thermal control following delivery is an essential part of neonatal care. Identifying the ideal body temperature in preterm neonates in the first few hours of lifemay be helpful to reduce the risk for adverse outcomes. Objectives: To examine the association between admission temperature and neonatal outcomes and estimate the admission temperature associated with lowest rates of adverse outcomes in preterm infants born at fewer than 33 weeks' gestation.. Design, Setting, And Participants: Retrospective observational study at 29 neonatal intensive care units in the Canadian Neonatal Network. Participants included 9833 inborn infants born at fewer than 33 weeks' gestation who were admitted between January 1, 2010, and December 31, 2012.. Exposure: Axillary or rectal body temperature recorded at admission.. Main Outcomes And Measures: The primary outcomewas a composite adverse outcome defined as mortality or any of the following: severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, or nosocomial infection. The relationships between admission temperature and the composite outcome as well as between admission temperature and the components of the composite outcome were evaluated using multivariable analyses.. Results: Admission temperatures of the 9833 neonates were distributed as follows: lower than 34.5°C (1%); 34.5°C to 34.9°C (1%); 35.0°C to 35.4°C (3%); 35.5°C to 35.9°C (7%); 36.0°C to 36.4°C (24%); 36.5°C to 36.9°C (38%); 37.0°C to 37.4°C (19%); 37.5°C to 37.9°C (5%); and 38.0°C or higher (2%). After adjustment for maternal and infant characteristics, the rates of the composite outcome, severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, and nosocomial infection had a U-shaped relationship with admission temperature (a > 0 [P < .05]). The admission temperature at which the rate of the composite outcome was lowest was 36.8°C (95%CI, 36.7°C-37.0°C). Rates of severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis (95%CI, 36.3°C-36.7°C), bronchopulmonary dysplasia, and nosocomial infection (95%CI, 36.9°C-37.3°C) were lowest at admission temperatures ranging from 36.5°C to 37.2°C.. Conclusions And Relevance: The relationship between admission temperature and adverse neonatal outcomes was U-shaped. The lowest rates of adverse outcomes were associated with admission temperatures between 36.5°C and 37.2°C..

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