目的 分析极低出生体重儿和/或胎龄小于32周早产儿入院体温的分布情况及低体温发生的危险因素,为降低入院低体温的发生率提供理论依据.方法 选取2019年1月1日-2020年12月31日聊城市人民医院出生的极低出生体重儿(出生体重＜1500 g)和/或胎龄＜32周早产儿共248例为研究对象;根据人院体温分为正常体温组(入院体温为36.5℃～37.5℃)122例、轻度低体温组(人院体温为36.0℃～36.4℃)98例、中度低体温组(入院体温为32.0℃～35.9℃)27例,记录三组病例的入院体温、一般资料及围生期资料,并进行统计分析.结果 248例极低出生体重儿和/或胎龄小于32周早产儿,入院体温波动于34.8℃～38.0℃,平均体温(36.37±0.44)℃.单因素分析及组间比较结果显示,中度低体温组胎龄、剖宫产比例小于正常体温组(H=12.316、x2=7.739,P＜0.05),出生时气管插管的比例大于正常体温组(x2=22.907,P＜0.05);中度低体温组和轻度低体温组出生体重小于正常体温组(H=26.060,P＜0.05),5 min Apgar评分≤7分及窒息复苏的比例大于正常体温组(x2=27.594、23.879,P＜0.05).多因素Logistic回归分析结果显示,出生体重(OR=0.997,95％CI:0.996～0.999)、多胎(OR=2.279,95％CI:1.106～4.694)和窒息复苏(OR=3.265,95％CI:1.209～8.819)为低体温的独立影响因素(P＜0.05).结论 极低出生体重儿和/或胎龄小于32周早产儿低体温的发生与多种因素相关,其中出生体重、多胎和窒息复苏是导致低体温的独立危险因素,可通过持续质量改进方案降低其入院低体温的发生率.

Background The objective of this prospective, multicentre, observational cohort study was to evaluate the association between admission hypothermia and neonatal outcomes in very low-birth weight (VLBW) infants in multiple neonatal intensive care units (NICUs) in China. Methods Since January 1, 2018, a neonatal homogeneous cooperative research platform-Shandong Neonatal Network (SNN) has been established. The platform collects clinical data in a prospective manner on preterm infants with birth weights (BWs) < 1500 g and gestational ages (GAs) < 34 weeks born in 28 NICUs in Shandong Province. These infants were divided into normothermia, mild or moderate/severe hypothermia groups according to the World Health Organization (WHO) classifications of hypothermia. Associations between outcomes and hypothermia were tested in a bivariate analysis, followed by a logistic regression analysis. Results A total of 1247 VLBW infants were included in this analysis, of which 1100 infants (88.2%) were included in the hypothermia group, 554 infants (44.4%) in the mild hypothermia group and 546 infants (43.8%) in the moderate/severe hypothermia group. Small for gestational age (SGA), caesarean section, a low Apgar score at 5 min and intubation in the delivery room (DR) were related to admission hypothermia (AH). Mortality was the lowest when their admission temperature was 36.5 ~ 37.5 °C, and after adjustment for maternal and infant characteristics, mortality was significantly associated with AH. Compared with infants with normothermia (36.5 ~ 37.5 °C), the adjusted ORs of all deaths increased to 4.148 (95% CI 1.505–11.437) and 1.806 (95% CI 0.651–5.009) for infants with moderate/severe hypothermia and mild hypothermia, respectively. AH was also associated with a high likelihood of respiratory distress syndrome (RDS), intraventricular haemorrhage (IVH), and late-onset neonatal sepsis (LOS). Conclusions AH is still very high in VLBW infants in NICUs in China. SGA, caesarean section, a low Apgar score at 5 min and intubation in the DR were associated with increased odds of hypothermia. Moderate/severe hypothermia was associated with mortality and poor outcomes, such as RDS, IVH, LOS.

Abstract Background Neonatal hypothermia, defined 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 significant.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 fulfilled 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 significantly 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.