Risk Factors Associated with Hypothermia Immediately after Birth among Preterm Infants

Jaewoo An; Bo Kyeong Jin; Heui Seung Jo; Hye-Rim Kim; Kee Hyun Cho; Kyu Hyung Lee

doi:10.14734/PN.2018.29.01.20

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An, Jin, Jo, Kim, Cho, and Lee: Risk Factors Associated with Hypothermia Immediately after Birth among Preterm Infants

Original Article

Perinatology 2018;29(1):20-26.

Published online: 19 March 2018

DOI: https://doi.org/10.14734/PN.2018.29.01.20

Risk Factors Associated with Hypothermia Immediately after Birth among Preterm Infants

Jaewoo An, MD¹, Bo Kyeong Jin, MD¹, Heui Seung Jo, MD¹, Hye-Rim Kim, MD¹, Kee Hyun Cho, MD², Kyu Hyung Lee, MD¹

¹Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam Korea

²Department of Pediatrics, CHA Gumi Medical Center, CHA University, Gumi, Korea

Correspondence to Heui Seung Jo, MD Department of Pediatrics, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundanggu, Seongnam 13496, Korea Tel: +82-31-780-5230 Fax: +82-31-780-3900 E-mail: joneona@cha.ac.kr

Received 5 September 201721 October 2017 Accepted 25 October 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The purpose of this study was to investigate the distribution of initial body temperature in premature infants admitted to the neonatal intensive care unit and to reveal the perinatal risk factors that may affect the incidence of hypothermia immediately after birth.

Methods

The subjects were 402 preterm infants born in CHA Bundang Medical Center at less than 32 weeks of gestation between January 2008 and December 2015. They were divided into two groups, the hypothermic group (body temperature <36°C) and the normothermic group (body temperature 36-37.5°C), and compared to investigate the distribution of body temperature. We also investigated perinatal characteristics associated with hypothermia at admission and 2 hours after admission.

Results

The incidence of hypothermia at admission was 33.5% in all patients, 50.9% of gestational age below 28 weeks and 48.4% of birth weight less than 1,000 g. Twenty-five (6.2%) infants did not gain appropriate body temperature within two hours after birth. Logistic regression analysis results showed that low birth weight, 1 minute Apgar score of <7 and gestational diabetes were hypothermic risk factors immediately after admission.

Conclusion

To prevent hypothermia at the time of admission in premature infants, more active treatment is needed to maintain body temperature from the place of delivery when gestational diabetes mellitus or Apgar score of <7 is present, in addition to low birth weight.

Keywords: Hypothermia, Premature infants, Risk factors

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Fig. 1

Body temperature distribution at neonatal intensive care unit (NICU) admission and 2 hours after hospitalization. NT0, normal body temperature group at NICU admission (n=267; 66.5%); HT0, hypothermia group at NICU admission (n=135; 33.5%); NT2, normal body temperature group at 2 hours in hospital (n=366; 91.1%); HT2, hypothermia group at 2 hours in hospital (n=34; 8.4%); a, continuous normal body temperature group (n=256; 63.8%); b: group whose body temperature decreased from normal (n=9; 2.2%); c, hyperthermia group at 2 hours in hospital (n=2; 0.5%); d, group whose body temperature improved to normal (n=110; 27.3%); e, continuously hypothermic group (n=25; 6.2%).

Fig. 2

Distribution of initial temperature at neonatal intensive care unit admission according to gestational age.

Fig. 3

Distribution of initial temperature at neonatal intensive care unit admission according to birth weight.

Table 1.

Demographics and Neonatal Outcomes of Study Population according to the Body Temperature at Admission

	HT0 group (n=135)	NT0 group (n=267)	Univariate analysis	Multivariate analysis
	HT0 group (n=135)	NT0 group (n=267)	P-value	aOR (95% CI)	P-value
Initial body temperature (°C)	35.5±0.4	36.4±0.3	<0.001	-	-
Gestational age (weeks)	28⁺²±2⁺²	29⁺²±1⁺⁶	<0.001	0.875 (0.735-1.041)	0.132
Birth weight (g)	1,155±342	1,390±358	<0.001	1.183 (1.068-1.309)	0.001∗
Male (%)	67 (49.6)	141 (52.6)	0.572	1.210 (0.755-1.941)	0.428
Twin (%)	47 (34.8)	85 (31.7)	0.532	1.134 (0.636-2.023)	0.670
C/S (%)	104 (77.0)	169 (63.1)	0.005	1.539 (0.882-2.684)	0.129
IVF (%)	41 (30.4)	66 (24.6)	0.218	1.090 (0.600-1.979)	0.778
AS <7 at 1 minute (%)	118 (87.4)	193 (72.3)	0.001	3.421 (1.679-6.971)	0.01
AS <7 at 5 minutes (%)	75 (55.6)	105 (39.3)	0.002	0.747 (0.425-1.313)	0.311
Resuscitation (%)	126 (93.3)	226 (84.3)	0.010	1.354 (0.585-3.134)	0.478
Antenatal corticosteroid (%)	75 (55.6)	123 (46.1)	0.072	1.674 (1.025-2.734)	0.040
PIH (%)	22 (16.3)	38 (14.2)	0.573	0.869 (0.447-1.690)	0.680
GDM (%)	18 (13.3)	18 (6.7)	0.028	2.561 (1.159-5.661)	0.020
Old mother ≥35 years (%)	45 (33.3)	61 (22.8)	0.023	1.452 (0.857-2.458)	0.165

Values are expressed as mean±standard deviation or number (%). Abbreviations: HT0 group, hypothermia group at neonatal intensive care unit admission; NT0 group, normal body temperature group at neonatal intensive care unit admission; aOR, adjusted odds ratio; CI, confidence interval; C/S, cesarean delivery; IVF, in vitro fertilization; AS, Apgar score; PIH, pregnancy induced hypertension; GDM, gestational diabetes mellitus.

^∗ Birth weights are transformed per 100 g unit.

Table 2.

Demographics and Neonatal Outcomes of Study Population according to Body Temperature 2 Hours after Hospitalization

HT2 group (n=34)		NT2 group (n=366)	Univariate analysis	Multivariate analysis
HT2 group (n=34)		NT2 group (n=366)	P-value	aOR (95% CI)	P-value
Two hours temperature	35.6±0.4	36.7±0.3	<0.001	-	-
Gestational age (wks)	27⁺⁶±2⁺¹	29⁺⁰±2⁺⁰	<0.001	0.879 (0.677-1.141)	0.347
Birth weight (g)	1,085±326	1,334±367	<0.001	1.075 (0.913-1.265)	0.378∗
Male (%)	19 (55.9)	189 (51.6)	0.625	1.514 (0.677-3.383)	0.289
Twin (%)	7 (20.6)	123 (33.6)	0.123	0.433 (0.152-1.231)	0.116
C/S (%)	28 (82.4)	243 (66.4)	0.054	2.987 (1.019-8.760)	0.046
IVF (%)	9 (26.5)	98 (26.8)	0.977	1.182 (0.441-3.164)	0.751
AS <7 at 1 minute (%)	32 (94.1)	278 (76.0)	0.014	3.293 (0.622-17.422)	0.160
AS <7 at 5 minutes (%)	25 (73.5)	154 (42.1)	<0.001	1.468 (0.537-4.015)	0.431
Antenatal corticosteroid (%)	20 (60.6)	177 (48.4)	0.173	2.028 (0.904-4.548)	0.097
PIH (%)	6 (17.6)	53 (14.5)	0.614	1.017 (0.365-2.831)	0.988
GDM (%)	2 (5.9)	34 (9.3)	0.509	0.701 (0.139-3.531)	0.662
Old mother ≥35 years (%)	9 (26.5)	97 (26.5)	0.996	0.643 (0.260-1.590)	0.318

^∗ Birth weights are transformed per 100 g unit.

Table 3.

Demographics and Neonatal Outcomes of Study Population according to Hypothermia Admission and 2 Hours after Hospitalization vs. Body Temperature Improved to Normal

E group (n=25)		D group (n=110)	Univariate analysis P-value	Multivariate analysis
E group (n=25)		D group (n=110)	Univariate analysis P-value	aOR (95% CI)	P-value
Initial body temperature	35.4±0.5	35.5±0.4	0.205	-
Two hours Body temperatur	e 35.5±0.4	36.6±0.4	<0.001	-
Gestational age (wks)	27⁺⁵±2⁺²	28⁺³±2⁺²	0.086	1.009 (0.735-1.385)	0.958
Birth weight (g)	1,034±331	1,182±340	0.048	1.089 (0.867-1.369)	0.462∗
Male (%)	15 (60.0)	52 (47.3)	0.251	0.600 (0.225-1.600)	0.308
Twin (%)	5 (20.0)	42 (38.2)	0.085	2.755 (0.649-11.692)	0.169
C/S (%)	20 (80.0)	84 (76.4)	0.696	0.662 (0.185-2.370)	0.526
IVF (%)	7 (28.0)	34 (30.9)	0.775	0.643 (0.173-2.397)	0.511
AS <7 at 1 minute (%)	24 (96.0)	94 (85.5)	0.151	0.363 (0.320-4.074)	0.412
AS <7 at 5 minutes (%)	18 (72.0)	57 (51.8)	0.067	0.740 (0.213-2.563)	0.634
Antenatal corticosteroid (%)	15 (60.0)	60 (54.5)	0.620	0.699 (0.260-1.881)	0.478
PIH (%)	4 (16.0)	18 (16.4)	0.703	1.301 (0.336-5.034)	0.703
GDM (%)	2 (8.0)	16 (14.5)	0.385	1.454 (0.273-7.742)	0.661
Old mother ≥35 years (%)	8 (32.0)	37 (33.6)	0.876	1.427 (0.479-4.247)	0.523

Values are expressed as mean±standard deviation or number (%). Adjested by gestational age, birth weight, male, twin, C/S, IVF. AS <7 at 1 minute, AS <7 at 5 minutes, resuscitation, antenatal corticosteroid, PIH, GDM, and old mother ≥35 years. Abbreviations: E group, continuously hypothermic group; D group, body temperature improved to normal; aOR, adjusted odds ratio; CI, confidence interval; C/S, cesarean delivery; IVF, in vitro fertilization; AS, Apgar score; PIH, pregnancy induced hypertension; GDM, gestational diabetes mellitus.

^∗ Birth weights are transformed per 100 g unit.

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