Impact of the Transition of Neonatal Body Temperature from Resuscitation to Admission on Prematurity Complications: A Retrospective Observational Study

Abstract

Objective

This study aimed to investigate the correlation between body temperature change from postbirth resuscitation (Tr) to admission (Ta), the impact of the transition of Tr to Ta, and the rate of Ta normalization on prematurity-related complications.

Study Design

A single-center retrospective observational study was conducted on inborn infants < 33 weeks gestational age, born between January 1, 2017, and May 31, 2021. Linear regression and multivariate logistic regression were used to evaluate the Tr-Ta relationship and to assess other associations. Normal body temperature was 36.5 to 37.5°C.

Results

From 568 eligible infants, 517 (91%) had both Tr and Ta records. Of these, 336/517 (65.0%) had normal Ta. And 80/336 infants (23.8%) with normal Ta had preceding abnormal Tr. Tr and Ta had a positive linear correlation (R ² = 0.23, p < 0.01). After adjusting for birth-to-NICU-admission time and perinatal factors, Tr hypothermia was associated with bronchopulmonary dysplasia (BPD; adjusted odds ratio [aOR]: 2.14, 95% confidence interval [CI]: 1.26–3.65, p < 0.01) and Ta hypothermia was associated with death before discharge (aOR: 2.98, 95% CI: 1.18–7.53, p = 0.02). Infants experiencing hypothermia during Tr to Ta transition were at a higher risk for periventricular leukomalacia (PVL), specifically, transition from Tr hypothermia to Ta normothermia/hyperthermia (aOR: 5.35, CI: 1.27–22.53, p = 0.02) and Tr hypothermia to Ta hypothermia (aOR: 4.72, CI: 1.13–19.79, p = 0.03). Transitioning from Tr hypothermia to Ta hypothermia was associated with a higher incidence of BPD (aOR: 1.84, 95% CI: 0.91–3.73, p = 0.09) and death (aOR: 2.96, 95% CI: 0.89–9.91, p = 0.08), though not statistically significant. Ta normalization at a rate of ≥0.5°C/hour was associated with a reduced risk of developing BPD.

Conclusion

Hypothermia during Tr-to-Ta transition was associated with an increased risk of PVL. Future research should explore the effects of abnormal temperature duration and magnitude on neonatal outcomes.

Key Points

• Impact of neonatal temperature transition on prematurity outcomes.

• Importance of early and continuous temperature monitoring.

• Hypothermia resulted in a higher chance of developing PVL.

Keywords

postresuscitation temperature - admission temperature - preterm - complications - mortality

• References

• 1 Liu J, Wu S, Zhu X. Advances in the prevention and treatment of neonatal hypothermia in early birth. Ther Hypothermia Temp Manag 2022; 12 (02) 51-56
• 2 World Health Organization. Maternal Health and Safe Motherhood Programme and Meeting of Technical Working Group on Thermal Control of the Newborn. Thermal control of the newborn: a practical guide. Geneva, Switzerland: WHO; 1993
• 3 Lyu Y, Shah PS, Ye XY. et al; Canadian Neonatal Network. Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks' gestation. JAMA Pediatr 2015; 169 (04) e150277
• 4 The American Academy of Pediatrics; American Heart Association. Textbook of Neonatal Resuscitation. 7th ed.. Weiner GM, Zaichkin J. Eds Elk Grove Village, IL: American Academy of Pediatrics and American Heart Association; 2016
• 5 Elbaum C, Beam KS, Dammann O, Dammann CEL. Antecedents and outcomes of hypothermia at admission to the neonatal intensive care unit. J Matern Fetal Neonatal Med 2021; 34 (01) 66-71
• 6 Yu YH, Wang L, Huang L. et al. Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study. BMC Pediatr 2020; 20 (01) 321
• 7 Lee NH, Nam SK, Lee J, Jun YH. Clinical impact of admission hypothermia in very low birth weight infants: results from Korean Neonatal Network. Korean J Pediatr 2019; 62 (10) 386-394
• 8 de Siqueira Caldas JP, Ferri WAG, Marba STM. et al. Admission hypothermia, neonatal morbidity, and mortality: evaluation of a multicenter cohort of very low birth weight preterm infants according to relative performance of the center. Eur J Pediatr 2019; 178 (07) 1023-1032
• 9 Laptook AR, Bell EF, Shankaran S. et al; Generic and Moderate Preterm Subcommittees of the NICHD Neonatal Research Network. Admission temperature and associated mortality and morbidity among moderately and extremely preterm infants. J Pediatr 2018; 192: 53-59.e2
• 10 Wilson E, Maier RF, Norman M. et al; Effective Perinatal Intensive Care in Europe (EPICE) Research Group. Admission hypothermia in very preterm infants and neonatal mortality and morbidity. J Pediatr 2016; 175: 61-67.e4
• 11 de Almeida MF, Guinsburg R, Sancho GA. et al; Brazilian Network on Neonatal Research. Hypothermia and early neonatal mortality in preterm infants. J Pediatr 2014; 164 (02) 271-5.e1
• 12 Mank A, van Zanten HA, Meyer MP, Pauws S, Lopriore E, Te Pas AB. Hypothermia in preterm infants in the first hours after birth: occurrence, course and risk factors. PLoS One 2016; 11 (11) e0164817
• 13 Rech Morassutti F, Cavallin F, Zaramella P, Bortolus R, Parotto M, Trevisanuto D. Association of rewarming rate on neonatal outcomes in extremely low birth weight infants with hypothermia. J Pediatr 2015; 167 (03) 557-61.e1 , 2
• 14 Jain P, Dalal JS, Gathwala G. Rapid vs. slow rewarming for management of moderate to severe hypothermia in low-birth-weight pre-term neonates-an open label randomized controlled trial. J Trop Pediatr 2021; 67 (01) fmaa098
• 15 Daga SR, Gajendragadkar A, Chutke P, Kamat H. Rapid rewarming of severely hypothermic newborns during initial stabilization. Acta Paediatr 1994; 83 (03) 263-264
• 16 Mathur NB, Krishnamurthy S, Mishra TK. Estimation of rewarming time in transported extramural hypothermic neonates. Indian J Pediatr 2006; 73 (05) 395-399
• 17 Bower BD, Jones LF, Weeks MM. Cold injury in the newborn. A study of 70 cases. BMJ 1960; 1 (5169) 303-309
• 18 Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991; 119 (03) 417-423
• 19 Higgins RD, Jobe AH, Koso-Thomas M. et al. Bronchopulmonary dysplasia: executive summary of a workshop. J Pediatr 2018; 197: 300-308
• 20 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
• 21 Patel RM, Ferguson J, McElroy SJ, Khashu M, Caplan MS. Defining necrotizing enterocolitis: current difficulties and future opportunities. Pediatr Res 2020; 88 (Suppl. 01) 10-15
• 22 Chiang MF, Quinn GE, Fielder AR. et al. International Classification of Retinopathy of Prematurity, Third Edition. Ophthalmology 2021; 128 (10) e51-e68
• 23 Anderson PJ, De Luca CR, Hutchinson E, Roberts G, Doyle LW. Victorian Infant Collaborative Group. Underestimation of developmental delay by the new Bayley-III Scale. Arch Pediatr Adolesc Med 2010; 164 (04) 352-356
• 24 Wilson E, Zeitlin J, Piedvache A. et al; EPICE Research Group. Cohort study from 11 European countries highlighted differences in the use and efficacy of hypothermia prevention strategies after very preterm birth. Acta Paediatr 2018; 107 (06) 958-966
• 25 Almeida PG, Chandley J, Davis J, Harrigan RC. Use of the heated gel mattress and its impact on admission temperature of very low birth-weight infants. Adv Neonatal Care 2009; 9 (01) 34-39
• 26 Chantaroj S, Techasatid W. Effect of polyethylene bag to prevent heat loss in preterm infants at birth: a randomized controlled trial. J Med Assoc Thai 2011; 94 (Suppl. 07) S32-S37
• 27 McCarthy LK, Molloy EJ, Twomey AR, Murphy JF, O'Donnell CP. A randomized trial of exothermic mattresses for preterm newborns in polyethylene bags. Pediatrics 2013; 132 (01) e135-e141
• 28 McGrory L, Owen LS, Thio M. et al. A randomized trial of conditioned or unconditioned gases for stabilizing preterm infants at birth. J Pediatr 2018; 193: 47-53
• 29 Jani P, Mishra U, Buchmayer J. et al. Thermoregulation and golden hour practices in extremely preterm infants: an international survey. Pediatr Res 2023; 93 (06) 1701-1709
• 30 Abiramalatha T, Ramaswamy VV, Bandyopadhyay T. et al. Delivery room interventions for hypothermia in preterm neonates: a systematic review and network meta-analysis. JAMA Pediatr 2021; 175 (09) e210775
• 31 Boo NY, Guat-Sim Cheah I. Malaysian National Neonatal Registry. Admission hypothermia among VLBW infants in Malaysian NICUs. J Trop Pediatr 2013; 59 (06) 447-452
• 32 Zanelli S, Buck M, Fairchild K. Physiologic and pharmacologic considerations for hypothermia therapy in neonates. J Perinatol 2011; 31 (06) 377-386
• 33 Zaghloul N, Ahmed M. Pathophysiology of periventricular leukomalacia: what we learned from animal models. Neural Regen Res 2017; 12 (11) 1795-1796
• 34 Abiramalatha T, Bandyopadhyay T, Ramaswamy VV. et al. Risk factors for periventricular leukomalacia in preterm infants: a systematic review, meta-analysis, and GRADE-based assessment of certainty of evidence. Pediatr Neurol 2021; 124: 51-71
• 35 Chang HY, Sung YH, Wang SM. et al. Short- and long-term outcomes in very low birth weight infants with admission hypothermia. PLoS One 2015; 10 (07) e0131976
• 36 Cavallin F, Calgaro S, Brugnolaro V. et al. Impact of temperature change from admission to day one on neonatal mortality in a low-resource setting. BMC Pregnancy Childbirth 2020; 20 (01) 646
• 37 Dollberg S, Rimon A, Atherton HD, Hoath SB. Continuous measurement of core body temperature in preterm infants. Am J Perinatol 2000; 17 (05) 257-264