A Multicentre Study on Admission Hypothermia in Very Low-Birth Weight Preterm Infants in China: Distribution, Causes and Risk Factors
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A multicentre study on admission hypothermia in very low-birth weight preterm infants in China: distribution, causes and risk factors Yong-hui Yu ( [email protected] ) Shandong Provincial Hospital https://orcid.org/0000-0001-7699-7482 Li Wang Shandong Provincial Hospital Xiao-yu Dong Shandong Provincial Hospital Wen Li Shandong University Qilu Hospital Lei Huang Shandong provincal maternity and child health care hospital Li-ling Wang Shandong Qianfoshan Hospital Xiu-fang Fan jinan maternity and child health care hospital Yan-qiu Wu Qindao University Medical College Aliated Yantai Yuhuangding Hospital Chun-lei Zhang weifang maternity and child health care hospital Xue-mei Sun Linyi People's Hospital Min Li linyi women's and children's hospital Yong-feng Zhang aliated hospital of weifang medical college Guo Yao Taian City Central Hospital Cong Li Liaocheng People's Hospital Guo-ying Zhao binzhou medical university hospital Xin-feng Zhao Page 1/18 zaozhuang maternity and child health care hospital Zhen-ying Yang taian maternity and child health care hospital Tong Chen dongying people's hospital Xue-yun Ren aliated hospital of jining medical college Jing Li the second aliated hospital of shandong rst medical university Bing-ping Qiu tengzhou centarl hospital Shi-ping Niu zibo maternity and child health care hospital Ren-xia Zhu people's hospital of linzi district,zibo Yao Chen centarl hospital of shandong provincial aliated to shandong university Yan-ling Gao dezhou people's hospital Ri-ming Zhao ju country people's hospital Li-ping Deng Heze Municipal Hospital Fu-dong Peng liaocheng second people's hospital Mei-rong Bi Jinan Central Hospital Aliated to Shandong University Research article Keywords: Hypothermia, very low-birth weight infants, NICU, Shandong China Posted Date: October 14th, 2019 DOI: https://doi.org/10.21203/rs.2.15988/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 2/18 Abstract Background Neonatal hypothermia, dened as a temperature < 36.5°C, is a major contributor to neonatal mortality and morbidity. Hypothermia in preterm infants remains a challenge in the neonatal intensive care unit (NICU) for many reasons. Objective To investigate the incidence of admission hypothermia (AH) in very low-birth weight (VLBW) infants in multiple NICUs in Shandong Province, China, and to provide clinical evidence for the implementation of quality improvement practices to reduce the incidence of AH in NICU. Methods This retrospective, observational study was carried out over a period of 12 months, from January 1, 2018 to December 31, 2018. The correlations between hypothermia preventive measures and the incidence of AH were analysed by descriptive statistical methods and a Spearman analysis. The associations between AH and maternal and neonatal variables were tested with bivariate analyses, followed by stepwise logistic regression. P <0.05 was considered statistically signicant. Results A total of 1639 in-born infants who were born at a weight less than 1500 g were enrolled in the study on their day of birth. Among them, 1295 VLBW infants fullled the inclusion criteria. The incidence of AH was 87.9% in VLBW infants among the 28 NICUs. We investigated whether team training and education, such as monthly chart reporting on hypothermia in preterm infants on admission to the NICU, which was associated with 10.7% of all the cases, could decrease the rate of AH. Indeed, transport with a heated transport incubator was associated with 9.3% of the cases. here was a negative correlation between the incidence of AH and the number of quality improvement measures implemented to prevent hypothermia (r= -0.242, p <0.05). A low birth weight, intubation in the delivery room , and a low 5-min Apgar score were signicantly associated with AH. Conclusion: The incidence of AH was high. There was a negative correlation between the incidence of AH and the number of quality improvement measures implemented to prevent hypothermia. It is important to monitor for AH in newborns who have a low birth weight, who have a low Apgar score at 5 min and who require intubation in the delivery room. Background Because of the immature physiological development of preterm infants, they are susceptible to heat loss, potentially leading to hypothermia, especially very low-birth weight (VLBW) infants and extremely low- birth weight (ELBW) infants [1]. The incidence of hypothermia on admission to the neonatal intensive care unit (NICU) in VLBW preterm infants is 31%–78%[2, 3]. Admission hypothermia (AH) is a vital risk factor for neonatal mortality and morbidity inpreterm infants [4, 5]. Maintaining normothermia in infants has been shown to improve survival and outcomes [6, 7]. In a multicentre study, Caldas et al. [8] reported that AH was signicantly associated with early neonatal death regardless of hospital performance. In Korea, Lee et al. [9] reported that 74.1% of 5860 VLBW preterm Page 3/18 infants (< 33 weeks of gestational age) with AH were admitted to neonatal units, and AH was associated with high mortality and several notable morbidities. Wilson et al. [10] reported that hypothermia occurred in 53.4% of 5697 infants born at <32 weeks of gestational age in a population-based study with samples from 11 European countries, and AH after very preterm birth was a signicant factor associated with an increased risk of early and late neonatal mortality. Lyu et al. [11] showed that the rates of the composite outcome, severe neurological injury, severe retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and nosocomial infection had U-shaped relationships with admission temperature, and the lowest rates of adverse outcomes were associated with admission temperatures between 36.5°C and 37.2°C. To reduce the rates of these complications, many clinical studies have suggested various measures to prevent hypothermia, including plastic wrapping without drying [12, 13, 14], the use of incubators [15], and the use of chemical mattresses [16]. Despite the knowledge and development of new approaches to better maintain infant body temperatures, recent studies have noted that a signicant proportion of VLBW infants in undeveloped countries are not kept suciently warm immediately after birth [10, 17]. The aim of this study was to investigate the distribution, causes and risk factors of AH in VLBW infants in multiple NICUs in China. Methods Study design and time period This retrospective, observational study was carried out over a period of 12 months, from January 1, 2018, to December 31, 2018, to investigate the incidence of AH in VLBW infants in multiple NICUs in Shandong Province, China. Study setting Shandong is located on the western shore of the Pacic; it has 3345 kilometres of coastline and borders on the Bohai Sea and the Yellow River, and its 158,000 square kilometres of landmass is home to over 100 million people. The study was conducted in twenty-eight public hospitals in Shandong, China, that have their own NICU. East Hospital of Shandong Provincial Hospital Aliated to Shandong University has its own NICU, with an average NICU admission rate of 75 neonates per month. Qilu Hospital of Shandong University has an average NICU admission rate of 121 neonates per month. Shandong Provincial Maternity and Child Health Care Hospital has an average NICU admission rate of 83 neonates per month. Qianfo Shan Hospital Aliated to Shandong University has an average NICU admission rate of 79 neonates per month. Jinan Maternity and Child Health Care Hospital has an average NICU admission of 180 neonates per month. Yantai Yuhuangding Hospital has an average NICU admission rate of 162 neonates per month. Weifang Maternity and Child Health Care Hospital has an average NICU admission rate of 326 neonates per month. Linyi People’s Hospital has an average NICU admission rate of 349 Page 4/18 neonates per month. Linyi Women’s and Children’s Hospital has an average NICU admission rate of 370 neonates per month. The Aliated Hospital of Weifang Medical College has an average NICU admission rate of 56 neonates per month. Taian Central Hospital has an average NICU admission rate of 171 neonates per month. Liaocheng People’s Hospital has an average NICU admission rate of 253 neonates per month. Binzhou Medical University Hospital has an average NICU admission rate of 193 neonates per month. Zaozhuang Maternity and Child Health Care Hospital has an average NICU admission rate of 185 neonates per month. Taian Maternity and Child Health Care Hospital has an average NICU admission rate of 153 neonates per month. Dongying People’s Hospital has an average NICU admission rate of 202 neonates per month. Aliated Hospital of Jining Medical College has an average NICU admission rate of 530 neonates per month. The Second Aliated Hospital of Shandong First Medical University has an average NICU admission rate of 100 neonates per month. Jinan Second Maternity and Child Health Care Hospital has an average NICU admission rate of 96 neonates per month. Tengzhou Central Hospital has an average NICU admission rate of 177 neonates per month. Zibo Maternity and Child Health Care Hospital has an average NICU admission rate of 161 neonates per month. The People’s Hospital of Linzi District, Zibo, has an average NICU admission rate of 56 neonates per month. Central Hospital of Shandong Provincial Aliated to Shandong University has an average NICU admission rate of 68 neonates per month. Ju County People’s Hospital has an average NICU admission rate of 109 neonates per month. Heze Municipal Hospital has an average NICU admission rate of 51 neonates per month. Liaocheng Second People’s Hospital has an average NICU admission rate of 72 neonates per month. Jinan Central Hospital has an average NICU admission rate of 49 neonates per month.