Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants

Abbot R Laptook; Edward F Bell; Seetha Shankaran; Nansi S Boghossian; Myra H Wyckoff; Sarah Kandefer; Michele Walsh; Shampa Saha; Rosemary Higgins; Generic and Moderate Preterm Subcommittees of the NICHD Neonatal Research Network

doi:10.1016/j.jpeds.2017.09.021

Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants

J Pediatr. 2018 Jan:192:53-59.e2. doi: 10.1016/j.jpeds.2017.09.021.

Authors

Abbot R Laptook¹, Edward F Bell², Seetha Shankaran³, Nansi S Boghossian⁴, Myra H Wyckoff⁵, Sarah Kandefer⁶, Michele Walsh⁷, Shampa Saha⁶, Rosemary Higgins⁸; Generic and Moderate Preterm Subcommittees of the NICHD Neonatal Research Network

Collaborators

Generic and Moderate Preterm Subcommittees of the NICHD Neonatal Research Network:
Richard A Polin⁹, Martin Keszler¹⁰, Betty R Vohr¹⁰, Angelita M Hensman¹⁰, Elisa Vieira¹⁰, Emilee Little¹⁰, Avroy A Fanaroff¹¹, Anna Marie Hibbs¹¹, Nancy S Newman¹¹, Bonnie S Siner¹¹, William E Truog¹², Eugenia K Pallotto¹², Howard W Kilbride¹², Cheri Gauldin¹², Anne Holmes¹², Kathy Johnson¹², Kurt Schibler¹³, Suhas G Kallapur¹³, Cathy Grisby¹³, Barbara Alexander¹³, Estelle E Fischer¹³, Lenora Jackson¹³, Kristin Kirker¹³, Jennifer Jennings¹³, Sandra Wuertz¹³, Greg Muthig¹³, Edward F Donovan¹³, Jody Hessling¹³, Marcia Worley Mersmann¹³, Holly L Mincey¹³, C Michael Cotten¹⁴, Ronald N Goldberg¹⁴, Joanne Finkle¹⁴, Kimberley A Fisher¹⁴, Kathy J Auten¹⁴, Matthew M Laughon¹⁴, Carl L Bose¹⁴, Janice Bernhardt¹⁴, Cindy Clark¹⁴, Barbara J Stoll¹⁵, David P Carlton¹⁵, Ellen C Hale¹⁵, Yvonne Loggins¹⁵, Diane I Bottcher¹⁵, Stephanie Wilson Archer¹⁶, Linda L Wright¹⁶, Elizabeth M McClure¹⁶, Brenda B Poindexter¹⁷, Gregory M Sokol¹⁷, Dianne E Herron¹⁷, James A Lemons¹⁷, Diana D Appel¹⁷, Lucy C Miller¹⁷, Pablo J Sanchez¹⁸, Leif D Nelin¹⁸, Sudarshan R Jadcherla¹⁸, Patricia Luzader¹⁸, Nehal A Parikh¹⁸, Marliese Dion Nist¹⁸, Jennifer Fuller¹⁸, Julie Gutentag¹⁸, Marissa E Jones¹⁸, Sarah McGregor¹⁸, Elizabeth Rodgers¹⁸, Jodi A Ulloa¹⁸, Tara Wolfe¹⁸, Abhik Das⁶, Dennis Wallace⁶, W Kenneth Poole⁶, Kristin M Zaterka-Baxter⁶, Margaret Crawford⁶, Jenna Gabrio⁶, Jeanette O'Donnell Auman⁶, Carolyn Petrie Huitema⁶, Betty K Hastings⁶, Krisa P Van Meurs¹⁹, David K Stevenson¹⁹, M Bethany Ball¹⁹, Melinda S Proud¹⁹, Waldemar A Carlo²⁰, Namasivayam Ambalavanan²⁰, Monica V Collins²⁰, Shirley S Cosby²⁰, Uday Devaskar²¹, Meena Garg²¹, Teresa Chanlaw²¹, Rachel Geller²¹, Tarah T Colaizy²², Dan L Ellsbury²², Jane E Brumbaugh²², Karen J Johnson²², Donia B Campbell²², Jacky R Walker²², Kristi L Watterberg²³, Robin K Ohls²³, Conra Backstrom Lacy²³, Sandra Sundquist Beauman²³, Carol Hartenberger²³, Barbara Schmidt²⁴, Haresh Kirpalani²⁴, Noah Cook²⁴, Sara B DeMauro²⁴, Aasma S Chaudhary²⁴, Soraya Abbasi²⁴, Toni Mancini²⁴, Dara Cucinotta²⁴, Carl T D'Angio²⁵, Ronnie Guillet²⁵, Satyan Lakshminrusimha²⁵, Dale L Phelps²⁵, Ann Marie Reynolds²⁵, Julianne Hunn²⁵, Rosemary Jensen²⁵, Holly I M Wadkins²⁵, Stephanie Guilford²⁵, Ashley Williams²⁵, Michael Sacilowski²⁵, Linda Reubens²⁵, Erica Burnell²⁵, Mary Rowan²⁵, Karen Wynn²⁵, Deanna Maffett²⁵, Luc P Brion²⁶, Diana M Vasil²⁶, Lijun Chen²⁶, Lizette E Torres²⁶, Walid A Salhab²⁶, Susie Madison²⁶, Gay Hensley²⁶, Nancy A Miller²⁶, Alicia Guzman²⁶, Kathleen A Kennedy²⁷, Jon E Tyson²⁷, Julie Arldt-McAlister²⁷, Carmen Garcia²⁷, Karen Martin²⁷, Georgia E McDavid²⁷, Sharon L Wright²⁷, Esther G Akpa²⁷, Patty A Cluff²⁷, Anna E Lis²⁷, Claudia I Franco²⁷, Athina Pappas²⁸, John Barks²⁸, Rebecca Bara²⁸, Shelley Handel²⁸, Geraldine Muran²⁸, Diane F White²⁸, Mary Christensen²⁸, Stephanie A Wiggins²⁸

Affiliations

¹ Department of Pediatrics, Brown University, Providence, RI. Electronic address: [email protected].
² Department of Pediatrics, University of Iowa, Iowa City, IA.
³ Department of Pediatrics, Wayne State University, Detroit, MI.
⁴ Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.
⁵ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
⁶ RTI International, Research Triangle Park, NC.
⁷ Department of Pediatrics, Case Western Reserve, Cleveland, OH.
⁸ Pregnancy and Perinatology Branch, National Institute of Child Health and Human Development, Bethesda, MD.
⁹ NRN Steering Committee Chair, Division of Neonatology, College of Physicians and Surgeons, Columbia University, New York, NY.
¹⁰ Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island, Providence, RI.
¹¹ Case Western Reserve University, Rainbow Babies & Children's Hospital, Cleveland, OH.
¹² Children's Mercy Hospital, Kansas City, MO.
¹³ Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical Center, Good Samaritan Hospital, Cincinnati, OH.
¹⁴ Duke University School of Medicine, University Hospital, University of North Carolina, Duke Regional Hospital, Durham, NC.
¹⁵ Emory University, Children's Healthcare of Atlanta, Grady Memorial Hospital, Emory University Hospital Midtown, Atlanta, GA.
¹⁶ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
¹⁷ Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children at Indiana University Health, Eskenazi Health, Indianapolis, IN.
¹⁸ Nationwide Children's Hospital and the Ohio State University Medical Center, Columbus, OH.
¹⁹ Stanford University and Lucile Packard Children's Hospital, Palo Alto, CA.
²⁰ University of Alabama at Birmingham Health System and Children's Hospital of Alabama, Birmingham, AL.
²¹ University of California - Los Angeles, Mattel Children's Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center, Olive View Medical Center, Los Angeles, CA.
²² University of Iowa and Mercy Medical Center, Iowa City, IA.
²³ University of New Mexico Health Sciences Center, Albuquerque, NM.
²⁴ University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital, Children's Hospital of Philadelphia, Philadelphia, PA.
²⁵ University of Rochester Medical Center, Golisano Children's Hospital, University of Buffalo Women's and Children's Hospital of Buffalo, Rochester, NY.
²⁶ University of Texas Southwestern Medical Center at Dallas, Parkland Health & Hospital System, Children's Medical Center Dallas, Dallas, TX.
²⁷ University of Texas Health Science Center at Houston Medical School, Children's Memorial Hermann Hospital, Lyndon Baines Johnson General Hospital, Memorial Hermann Southwest Hospital, Houston, TX.
²⁸ Wayne State University, University of Michigan, Hutzel Women's Hospital, Children's Hospital of Michigan, Detroit, MI.

Abstract

Objective: To evaluate the temperature distribution among moderately preterm (MPT, 29-33 weeks) and extremely preterm (EPT, <29 weeks) infants upon neonatal intensive care unit (NICU) admission in 2012-2013, the change in admission temperature distribution for EPT infants between 2002-2003 and 2012-2013, and associations between admission temperature and mortality and morbidity for both MPT and EPT infants.

Study design: Prospectively collected data from 18 centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were used to examine NICU admission temperature of inborn MPT and EPT infants. Associations between admission temperature and mortality and morbidity were determined by multivariable logistic regression. EPT infants from 2002-2003 and 2012-2013 were compared.

Results: MPT and EPT cohorts consisted of 5818 and 3213 infants, respectively. The distribution of admission temperatures differed between the MPT vs EPT (P < .01), including the percentage <36.5°C (38.6% vs 40.9%), 36.5°C-37.5°C (57.3% vs 52.9%), and >37.5°C (4.2% vs 6.2%). For EPT infants in 2012-2013 compared with 2002-2003, the percentage of temperatures between 36.5°C and 37.5°C more than doubled and the percentage of temperatures >37.5°C more than tripled. Admission temperature was inversely associated with in-hospital mortality.

Conclusions: Low and high admission temperatures are more frequent among EPT than MPT infants. Compared with a decade earlier, fewer EPT infants experience low admission temperatures but more have elevated temperatures. In spite of a change in distribution of NICU admission temperature, an inverse association between temperature and mortality risk persists.

Keywords: hyperthermia; hypothermia; prematurity; survival.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Body Temperature*
Female
Fever / diagnosis
Fever / epidemiology
Hospital Mortality*
Humans
Hypothermia / diagnosis
Hypothermia / epidemiology
Infant, Extremely Premature*
Infant, Newborn
Infant, Premature, Diseases / diagnosis
Infant, Premature, Diseases / epidemiology
Infant, Premature, Diseases / etiology*
Intensive Care Units, Neonatal
Logistic Models
Male
Patient Admission
Risk Factors
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding