title: Hypothermia and early neonatal mortality in preterm infants.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  Hypothermia 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).
  
  
  CONCLUSIONS
  Simple 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.
authors.affiliation: Division of Neonatal Medicine, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil.
authors.forename: Maria Fernanda Branco
authors.initials: MF
authors.lastname: de Almeida
authors.affiliation: Division of Neonatal Medicine, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil. Electronic address: ruthgbr@netpoint.com.br.
authors.forename: Ruth
authors.initials: R
authors.lastname: Guinsburg
authors.affiliation: Division of Neonatal Medicine, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil.
authors.forename: Guilherme Assis
authors.initials: GA
authors.lastname: Sancho
authors.affiliation: Department of Pediatrics, Universidade Estadual de Campinas/Hospital da Mulher Prof. Dr. José Aristodemo Pinotti, Campinas, SP, Brazil.
authors.forename: Izilda Rodrigues Machado
authors.initials: IR
authors.lastname: Rosa
authors.affiliation: Department of Public Health, Universidade Federal do Maranhão/Hospital Universitário, São Luís, MA, Brazil.
authors.forename: Zeni Carvalho
authors.initials: ZC
authors.lastname: Lamy
authors.affiliation: Department of Pediatrics, Universidade de São Paulo/Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, SP, Brazil.
authors.forename: Francisco Eulógio
authors.initials: FE
authors.lastname: Martinez
authors.affiliation: Department of Pediatrics, Universidade Federal do Paraná/Hospital de Clínicas, Curitiba, PR, Brazil.
authors.forename: Regina Paula Guimarães Vieira Cavalcante
authors.initials: RP
authors.lastname: da Silva
authors.affiliation: Department of Pediatrics and Pediatric Surgery, Universidade Estadual de Londrina/Hospital Universitário, Londrina, PR, Brazil.
authors.forename: Lígia Silvana Lopes
authors.initials: LS
authors.lastname: Ferrari
authors.affiliation: Department of Pediatrics, Faculdade de Medicina de Botucatu da Universidade Estadual Paulista, Botucatu, SP, Brazil.
authors.forename: Ligia Maria Suppo
authors.initials: LM
authors.lastname: de Souza Rugolo
authors.affiliation: Department of Pediatrics, Universidade Federal de Uberlândia/Hospital de Clínicas, Uberlândia, MG, Brazil.
authors.forename: Vânia Olivetti Steffen
authors.initials: VO
authors.lastname: Abdallah
authors.affiliation: Department of Pediatrics, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Rita de Cássia
authors.initials: Rde C
authors.lastname: Silveira
mesh_terms: D001938:Brazil / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007035:Hypothermia / Q000401:mortality*; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends
keywords: DR; Delivery room; NICU; Neonatal intensive care unit; VLBW; Very low birth weight