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
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.
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.
KeywordsHypothermia Premature newborns Death Morbidity
Effective Perinatal Intensive Care in Europe
- SNAPPE II
Score for Neonatal Acute Physiology with Perinatal Extension-II
Very low birth weight
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.
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.
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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