Association between hypothermia and mortality rate of premature infants—Revisited

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The incidence of hypothermia (axillary temperature <35°C) on admission of an infant to a neonatal intensive care unit was retrospectively analyzed in 559 very-low-birth-weight (<1500 gm) newborn infants. The smaller infants were at greater risk of hypothermia. Only in the larger neonates was mortality related to hypothermia, which suggests that this known association bears little cause-effect relationship.

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    Exposure of the newborn to cold stress will lower arterial oxygen tension28 and increase metabolic acidosis.29 The association between hypothermia and mortality has been known for more than a century,30 and the admission temperature of newborn non-asphyxiated infants is a strong predictor of mortality at all gestations and in all settings.31–65 Preterm infants are especially vulnerable and hypothermia is also associated with serious morbidities such as intraventricular haemorrhage35,42,55,66–69 need for respiratory support31,35,37,66,70–74 hypoglycaemia31,49,60,74–79 and in some studies late onset sepsis.49

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    In nonasphyxiated babies at birth (P), does maintenance of normothermia (core temperature 36.5 °C or greater and 37.5 °C or less) from delivery to admission (I), compared with hypothermia (less than 36 °C) or hyperthermia (greater than 37.5 °C) (C), change survival to hospital discharge, respiratory distress, survival to admission, hypoglycemia, intracranial hemorrhage, or infection rate (O)? For the critical outcome of mortality, there is evidence from 36 observational studies of increased risk of mortality associated with hypothermia at admission42–77 (low-quality evidence but upgraded to moderate-quality evidence due to effect size, dose–effect relationship, and single direction of evidence). There is evidence of a dose–effect relationship on mortality, suggesting an increased risk of at least 28% for each 1° below 36.5 °C body temperature at admission42,43 and dose-dependent effect size.42,43,48,66

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    Despite modern resuscitation techniques, 40–50% of premature newborns still experience hypothermia [2–4]. Of particular concern hypothermia is recognized as an independent risk factor for death in premature newborn infants [2,5–11]. At the time of our trial's conception, the standard of care for reducing heat loss following birth, as described by the Neonatal Resuscitation Program (NRP) guidelines, is to immediately dry all newborns under radiant heat after delivery [12].

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1

From the Perinatal Service, Hôpital Sainte-Justine, and the Department of Pediatrics and the Department of Computer Science and Operations Research, University of Montreal.

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