title: Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks' gestation.
abstract: OBJECTIVE
  Neonatal hypothermia has been associated with higher mortality and morbidity; therefore, thermal control following delivery is an essential part of neonatal care. Identifying the ideal body temperature in preterm neonates in the first few hours of life may be helpful to reduce the risk for adverse outcomes.
  
  
  OBJECTIVE
  To examine the association between admission temperature and neonatal outcomes and estimate the admission temperature associated with lowest rates of adverse outcomes in preterm infants born at fewer than 33 weeks' gestation.
  
  
  METHODS
  Retrospective observational study at 29 neonatal intensive care units in the Canadian Neonatal Network. Participants included 9833 inborn infants born at fewer than 33 weeks' gestation who were admitted between January 1, 2010, and December 31, 2012.
  
  
  METHODS
  Axillary or rectal body temperature recorded at admission.
  
  
  METHODS
  The primary outcome was a composite adverse outcome defined as mortality or any of the following: severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, or nosocomial infection. The relationships between admission temperature and the composite outcome as well as between admission temperature and the components of the composite outcome were evaluated using multivariable analyses.
  
  
  RESULTS
  Admission temperatures of the 9833 neonates were distributed as follows: lower than 34.5°C (1%); 34.5°C to 34.9°C (1%); 35.0°C to 35.4°C (3%); 35.5°C to 35.9°C (7%); 36.0°C to 36.4°C (24%); 36.5°C to 36.9°C (38%); 37.0°C to 37.4°C (19%); 37.5°C to 37.9°C (5%); and 38.0°C or higher (2%). After adjustment for maternal and infant characteristics, the rates of the composite outcome, severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, and nosocomial infection had a U-shaped relationship with admission temperature (α > 0 [P < .05]). The admission temperature at which the rate of the composite outcome was lowest was 36.8°C (95% CI, 36.7°C-37.0°C). Rates of severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis (95% CI, 36.3°C-36.7°C), bronchopulmonary dysplasia, and nosocomial infection (95% CI, 36.9°C-37.3°C) were lowest at admission temperatures ranging from 36.5°C to 37.2°C.
  
  
  CONCLUSIONS
  The relationship between admission temperature and adverse neonatal outcomes was U-shaped. The lowest rates of adverse outcomes were associated with admission temperatures between 36.5°C and 37.2°C.
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada2Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada3Capital Institute of Pediatrics, Beijing, China.
authors.forename: Yanyu
authors.initials: Y
authors.lastname: Lyu
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada2Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Xiang Y
authors.initials: XY
authors.lastname: Ye
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Warre
authors.affiliation: Centre Hospitalier Universitaire de Québec, Québec City, Canada.
authors.forename: Bruno
authors.initials: B
authors.lastname: Piedboeuf
authors.affiliation: Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada.
authors.forename: Akhil
authors.initials: A
authors.lastname: Deshpandey
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada6Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Dunn
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada2Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shoo K
authors.initials: SK
authors.lastname: Lee
mesh_terms: D001831:Body Temperature; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000150:complications; D006801:Humans; D007035:Hypothermia / Q000150:complications; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology; D012189:Retrospective Studies