PDF(Pubmed)
Abstract：
BACKGROUND: Hypothermia 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.
METHODS: We 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.
RESULTS: Of 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.
CONCLUSIONS: The 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.
METHODS: We 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.
RESULTS: Of 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.
CONCLUSIONS: The 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.
摘要：
背景：低体温是早产和低出生体重新生儿发病和死亡的重要原因。在资源受限的设置中，有限的转诊基础设施和温度控制技术会增强早产低体温。虽然单中心研究有一些关于入院时体温过低的文件，在资源有限的环境中,关于早产儿低体温发生率的多中心研究有限.因此,我们在尼日利亚北部进行了一项多中心研究,以确定入院时和入院后前72小时内体温过低的患病率和危险因素.
方法：我们在2020年8月至2021年7月期间对尼日利亚北部四家转诊医院收治的早产儿进行了一项前瞻性队列研究。我们记录了入院时的温度测量值以及入院后前72小时的最低和最高温度。我们还收集了有关社会人口统计学和围产期历史数据的个人婴儿水平数据。我们使用世界卫生组织的低温分类来将婴儿的体温分类为轻度，中度,和严重的体温过低.使用泊松回归分析来确定中重度低体温的危险因素。
结果：在933名早产儿中，682例(72.9%)患者入院时体温过低,尽管四所医院的体温过低发生率不同。在入院后的第一个24小时内，每10个婴儿中就有7个出现体温过低。入院后72小时，在4家医院中,10%至40%的早产儿发生过至少1次中度低体温.妊娠年龄（OR=0.86；CI=0.82-0.91），出生体重（OR=8.11；CI=2.87-22.91），分娩时存在熟练的接生员（OR=0.53；CI=0.29-0.95），分娩地点(OR=1.94CI=1.13-3.33)和出生时复苏(OR=1.79;CI=1.27-2.53)是与低体温相关的显著危险因素.
结论：早产儿入院时体温过低的发生率很高，而且体温过低与低出生体重有关，分娩地点和熟练的接生员。在护理中体温过低的患病率也很高，这对患者安全和患者护理质量具有重要意义。需要为早产儿提供转诊服务，同时医院需要更好的设备来保持入院的小新生儿和患病新生儿的体温。
方法：我们在2020年8月至2021年7月期间对尼日利亚北部四家转诊医院收治的早产儿进行了一项前瞻性队列研究。我们记录了入院时的温度测量值以及入院后前72小时的最低和最高温度。我们还收集了有关社会人口统计学和围产期历史数据的个人婴儿水平数据。我们使用世界卫生组织的低温分类来将婴儿的体温分类为轻度，中度,和严重的体温过低.使用泊松回归分析来确定中重度低体温的危险因素。
结果：在933名早产儿中，682例(72.9%)患者入院时体温过低,尽管四所医院的体温过低发生率不同。在入院后的第一个24小时内，每10个婴儿中就有7个出现体温过低。入院后72小时，在4家医院中,10%至40%的早产儿发生过至少1次中度低体温.妊娠年龄（OR=0.86；CI=0.82-0.91），出生体重（OR=8.11；CI=2.87-22.91），分娩时存在熟练的接生员（OR=0.53；CI=0.29-0.95），分娩地点(OR=1.94CI=1.13-3.33)和出生时复苏(OR=1.79;CI=1.27-2.53)是与低体温相关的显著危险因素.
结论：早产儿入院时体温过低的发生率很高，而且体温过低与低出生体重有关，分娩地点和熟练的接生员。在护理中体温过低的患病率也很高，这对患者安全和患者护理质量具有重要意义。需要为早产儿提供转诊服务，同时医院需要更好的设备来保持入院的小新生儿和患病新生儿的体温。
