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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

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Abstract

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.

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Abbreviations

AH:

Admission hypothermia

BDP:

Bronchopulmonary dysplasia

CI:

Confidence intervals

EPICE:

Effective Perinatal Intensive Care in Europe

NEC:

Necrotizing enterocolitis

PIVH:

Peri-intraventricular hemorrhage

RR:

Relative risk

SNAPPE II:

Score for Neonatal Acute Physiology with Perinatal Extension-II

VLBW:

Very low birth weight

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, Brazil

    Jamil Pedro de Siqueira Caldas & Sérgio T. M. Marba

  2. Campinas, Brazil

    Jamil Pedro de Siqueira Caldas

  3. Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14049-900, Brazil

    Walusa A. G. Ferri & Davi C. Aragon

  4. São Paulo, Brazil

    Sérgio T. M. Marba, Ruth Guinsburg, Maria F. B. de Almeida, Marco B. Pavanelli & Maria R. Bentlin

  5. Division of Neonatal Medicine, Federal University of São Paulo, São Paulo, Brazil

    Ruth Guinsburg, Maria F. B. de Almeida & Mandira D. Kawakami

  6. Department of Pediatrics, University of São Paulo, School of Medicine, São Paulo, Brazil

    Edna M. A. Diniz & Werther B. Carvalho

  7. Instituto da Criança, Av Dr. Enéas de Carvalho Aguiar, 647, Pinheiros, São Paulo, São Paulo, 05403-000, Brazil

    Edna M. A. Diniz & Werther B. Carvalho

  8. Division of Neonatology, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre –HCPA, Rua Silva Jardim 1155/701, Porto Alegre, Rio Grande do Sul, 90450071, Brazil

    Rita C. S. Silveira

  9. Department of Pediatrics, Maternidade Hilda Brandão - Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil

    José M. S. Alves Junior

  10. Belo Horizonte, Brazil

    José M. S. Alves Junior

  11. Neonatal Unit, Hospital Geral de Pirajussara, Taboão da Serra, Brazil

    Marco B. Pavanelli

  12. Division of Neonatology, Faculdade de Medicina de Botucatu da, Universidade Estadual Paulista, Botucatu, Brazil

    Maria R. Bentlin

  13. Department of Pediatrics, Universidade Federal de Uberlândia, Uberlândia, Brazil

    Daniela M. L. M. Ferreira

  14. Uberlândia, Brazil

    Daniela M. L. M. Ferreira

  15. Department of Pediatrics, Universidade Federal do Maranhão, São Luís, Brazil

    Marynéa S. Vale

  16. São Luís, Brazil

    Marynéa S. Vale

  17. Department of Pediatrics, Hospital São Lucas - Faculdade de Medicina da, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil

    Humberto H. Fiori

  18. Porto Alegre, Brazil

    Humberto H. Fiori

  19. Department of Pediatrics, Hospital Universitário Pedro Ernesto - Universidade do Estado de Rio de Janeiro, Rio de Janeiro, Brazil

    José L. M. B. Duarte

  20. Rio de Janeiro, Brazil

    José L. M. B. Duarte & Silvia Cwajg

  21. Department of Pediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil

    Jucille A. Meneses

  22. Recife, Brazil

    Jucille A. Meneses

  23. Division of Neonatology, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil

    Silvia Cwajg

  24. Department of Pediatrics, Hospital Universitário - Universidade Estadual de Londrina, Curitiba, Brazil

    Lígia S. L. Ferrari

  25. Londrina, Brazil

    Lígia S. L. Ferrari

  26. Neonatal Unit, Hospital Estadual de Diadema, Diadema, Brazil

    Nathalia M. M. Silva

  27. Diadema, Brazil

    Nathalia M. M. Silva

  28. Department of Pediatrics, Hospital de Clínicas - Universidade Federal do Paraná, Curitiba, Brazil

    Regina P. G. V. C. da Silva

  29. Curitiba, Brazil

    Regina P. G. V. C. da Silva

  30. Division of Neonatology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

    Leni M. Anchieta

  31. Belo Horizonte, Brazil

    Leni M. Anchieta

  32. Neonatal Division, Hospital Estadual Sumaré, Sumaré, Brazil

    Juliana P. F. Santos

  33. Sumaré, Brazil

    Juliana P. F. Santos

  34. Atibaia, Brazil

    Mandira D. Kawakami

Authors
  1. Jamil Pedro de Siqueira Caldas
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  2. Walusa A. G. Ferri
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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.

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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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Communicated by Patrick Van Reempts

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de Siqueira Caldas, J.P., Ferri, W.A.G., Marba, S.T.M. et al. 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. Eur J Pediatr 178, 1023–1032 (2019). https://doi.org/10.1007/s00431-019-03386-9

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