• Maria Fernanda Branco de Almeida, Ruth Guinsburg, Guilherme Assis Sancho, Izilda Rodrigues Machado Rosa, Zeni Carvalho Lamy, Francisco Eulógio Martinez, Regina Paula Guimarães Vieira Cavalcante da Silva, Lígia Silvana Lopes Ferrari, Ligia Maria Suppo de Souza Rugolo, Vânia Olivetti Steffen Abdallah, Rita de Cássia Silveira, and Brazilian Network on Neonatal Research.
• Division of Neonatal Medicine, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil.
• J. Pediatr. 2014 Feb 1;164(2):271-5.e1.

ObjectiveTo evaluate intervention practices associated with hypothermia at both 5 minutes after birth and at neonatal intensive care unit (NICU) admission and to determine whether hypothermia at NICU admission is associated with early neonatal death in preterm infants.Study DesignThis prospective cohort included 1764 inborn neonates of 22-33 weeks without malformations admitted to 9 university NICUs from August 2010 through April 2012. All centers followed neonatal International Liaison Committee on Resuscitation recommendations for the stabilization and resuscitation in the delivery room (DR). Variables associated with hypothermia (axillary temperature <36.0 °C) 5 minutes after birth and at NICU admission, as well as those associated with early death, were analyzed by logistic regression.ResultsHypothermia 5 minutes after birth and at NICU admission was noted in 44% and 51%, respectively, with 6% of early neonatal deaths. Adjusted for confounding variables, practices associated with hypothermia at 5 minutes after birth were DR temperature <25 °C (OR 2.13, 95% CI 1.67-2.28), maternal temperature at delivery <36.0 °C (OR 1.93, 95% CI 1.49-2.51), and use of plastic bag/wrap (OR 0.53, 95% CI 0.40-0.70). The variables associated with hypothermia at NICU admission were DR temperature <25 °C (OR 1.44, 95% CI 1.10-1.88), respiratory support with cold air in the DR (OR 1.40, 95% CI 1.03-1.88) and during transport to NICU (OR 1.51, 95% CI 1.08-2.13), and cap use (OR 0.55, 95% CI 0.39-0.78). Hypothermia at NICU admission increased the chance of early neonatal death by 1.64-fold (95% CI 1.03-2.61).ConclusionSimple interventions, such as maintaining DR temperature >25 °C, reducing maternal hypothermia prior to delivery, providing plastic bags/wraps and caps for the newly born infants, and using warm resuscitation gases, may decrease hypothermia at NICU admission and improve early neonatal survival.Copyright © 2014 Mosby, Inc. All rights reserved.

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