European Journal of Pediatrics

, Volume 178, Issue 7, pp 1023–1032 | Cite as

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

  • Jamil Pedro de Siqueira Caldas
  • Walusa A. G. Ferri
  • Sérgio T. M. Marba
  • Davi C. Aragon
  • Ruth Guinsburg
  • Maria F. B. de Almeida
  • Edna M. A. Diniz
  • Rita C. S. Silveira
  • José M. S. Alves Junior
  • Marco B. Pavanelli
  • Maria R. Bentlin
  • Daniela M. L. M. Ferreira
  • Marynéa S. Vale
  • Humberto H. Fiori
  • José L. M. B. Duarte
  • Jucille A. Meneses
  • Silvia Cwajg
  • Werther B. Carvalho
  • Lígia S. L. Ferrari
  • Nathalia M. M. Silva
  • Regina P. G. V. C. da Silva
  • Leni M. Anchieta
  • Juliana P. F. Santos
  • Mandira D. Kawakami
Original Article


This prospective cohort study aimed to assess the association of admission hypothermia (AH) with death and/or major neonatal morbidities among very low birth weight (VLBW) preterm infants based on the relative performance of 20 centers of the Brazilian Network of Neonatal Research. This is a retrospective analysis of prospectively collected data using the database registry of the Brazilian Network on Neonatal Research. Center performance was defined by the relative mortality rate using conditional inference trees. A total of 4356 inborn singleton VLBW preterm infants born between January 2013 and December 2016 without malformations were included in this study. The centers were divided into two groups: G1 (with lower mortality rate) and G2 (with higher mortality rate). Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were estimated by simple and multiple log-binomial regression models. An AH rate of 53.7% (19.8–93.3%) was significantly associated with early neonatal death in G1 (adjusted RR 1.41, 95% CI 1.09–1.84) and G2 (adjusted RR 1.29, 95%CI 1.01–1.65) and with in-hospital death in G1 (adjusted RR 1.29, 95%CI 1.07–1.58). AH was significantly associated with a lower frequency of necrotizing enterocolitis (adjusted RR 0.58, 95%CI 38–0.88) in G2.

Conclusion: AH significantly associated with early neonatal death regardless of the hospital performance. In G2, an unexpected protective association between AH and necrotizing enterocolitis was found, whereas the other morbidities assessed were not significantly associated with AH.

What is Known:

Admission hypothermia is associated with early neonatal death.

• The association of admission hypothermia with major neonatal morbidities has not been fully established.

What is New:

Admission hypothermia was significantly associated with early neonatal and in-hospital death in centers with the lowest relative mortality rates.

• Admission hypothermia was not associated with major neonatal morbidities and with in-hospital death but was found to be a protective factor against necrotizing colitis in centers with the highest relative mortality rates.


Hypothermia Premature newborns Death Morbidity 



Admission hypothermia


Bronchopulmonary dysplasia


Confidence intervals


Effective Perinatal Intensive Care in Europe


Necrotizing enterocolitis


Peri-intraventricular hemorrhage


Relative risk


Score for Neonatal Acute Physiology with Perinatal Extension-II


Very low birth weight


Authors’ contributions

Jamil Pedro de Siqueira Caldas, Walusa A. G. Ferri, Sérgio T.M.Marba, Davi C. Aragon, Ruth Guinsburg and Maria F.B. de Almeida have participated in the concept and design, analysis and interpretation of data, and drafting and revising the manuscript. All other authors have participated in the design of the study, collection and interpretation of data and revising the manuscript. All authors listed on the manuscript approved the submission of this version of the manuscript and take full responsibility for the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. Ethical approval number: 1.903.783 - Federal University of São Paulo, São Paulo.

Informed consent

All centers agreed to have their data included in this study, and the Research Ethics Committee of the coordinating institution approved the project without needing patients’ informed consent: 1.903.783.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jamil Pedro de Siqueira Caldas
    • 1
    • 2
  • Walusa A. G. Ferri
    • 3
  • Sérgio T. M. Marba
    • 1
    • 4
  • Davi C. Aragon
    • 3
  • Ruth Guinsburg
    • 4
    • 5
  • Maria F. B. de Almeida
    • 4
    • 5
  • Edna M. A. Diniz
    • 6
    • 7
  • Rita C. S. Silveira
    • 8
  • José M. S. Alves Junior
    • 9
    • 10
  • Marco B. Pavanelli
    • 4
    • 11
  • Maria R. Bentlin
    • 4
    • 12
  • Daniela M. L. M. Ferreira
    • 13
    • 14
  • Marynéa S. Vale
    • 15
    • 16
  • Humberto H. Fiori
    • 17
    • 18
  • José L. M. B. Duarte
    • 19
    • 20
  • Jucille A. Meneses
    • 21
    • 22
  • Silvia Cwajg
    • 20
    • 23
  • Werther B. Carvalho
    • 6
    • 7
  • Lígia S. L. Ferrari
    • 24
    • 25
  • Nathalia M. M. Silva
    • 26
    • 27
  • Regina P. G. V. C. da Silva
    • 28
    • 29
  • Leni M. Anchieta
    • 30
    • 31
  • Juliana P. F. Santos
    • 32
    • 33
  • Mandira D. Kawakami
    • 5
    • 34
  1. 1.Department of PediatricsFaculdade de Ciências Médicas da Universidade Estadual de CampinasCampinasBrazil
  2. 2.CampinasBrazil
  3. 3.Department of Pediatrics, Faculdade de Medicina de Ribeirão PretoUniversity of São PauloRibeirão PretoBrazil
  4. 4.São PauloBrazil
  5. 5.Division of Neonatal MedicineFederal University of São PauloSão PauloBrazil
  6. 6.Department of PediatricsUniversity of São Paulo, School of MedicineSão PauloBrazil
  7. 7.Instituto da CriançaSão PauloBrazil
  8. 8.Division of NeonatologyUniversidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre –HCPAPorto AlegreBrazil
  9. 9.Department of PediatricsMaternidade Hilda Brandão - Faculdade de Ciências Médicas de Minas GeraisBelo HorizonteBrazil
  10. 10.Belo HorizonteBrazil
  11. 11.Neonatal UnitHospital Geral de PirajussaraTaboão da SerraBrazil
  12. 12.Division of Neonatology, Faculdade de Medicina de Botucatu daUniversidade Estadual PaulistaBotucatuBrazil
  13. 13.Department of PediatricsUniversidade Federal de UberlândiaUberlândiaBrazil
  14. 14.UberlândiaBrazil
  15. 15.Department of PediatricsUniversidade Federal do MaranhãoSão LuísBrazil
  16. 16.São LuísBrazil
  17. 17.Department of Pediatrics, Hospital São Lucas - Faculdade de Medicina daPontifícia Universidade Católica do Rio Grande do SulPorto AlegreBrazil
  18. 18.Porto AlegreBrazil
  19. 19.Department of PediatricsHospital Universitário Pedro Ernesto - Universidade do Estado de Rio de JaneiroRio de JaneiroBrazil
  20. 20.Rio de JaneiroBrazil
  21. 21.Department of PediatricsInstituto de Medicina Integral Professor Fernando FigueiraRecifeBrazil
  22. 22.RecifeBrazil
  23. 23.Division of NeonatologyFundacao Oswaldo CruzRio de JaneiroBrazil
  24. 24.Department of PediatricsHospital Universitário - Universidade Estadual de LondrinaCuritibaBrazil
  25. 25.LondrinaBrazil
  26. 26.Neonatal UnitHospital Estadual de DiademaDiademaBrazil
  27. 27.DiademaBrazil
  28. 28.Department of PediatricsHospital de Clínicas - Universidade Federal do ParanáCuritibaBrazil
  29. 29.CuritibaBrazil
  30. 30.Division of NeonatologyUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  31. 31.Belo HorizonteBrazil
  32. 32.Neonatal DivisionHospital Estadual SumaréSumaréBrazil
  33. 33.SumaréBrazil
  34. 34.AtibaiaBrazil

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