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Body temperature instability and respiratory morbidity in the very low birth weight infant: a multiple case,
Jane L Ralphe1, Susan G Silva2,3, Robin B Dail4
1University of Wisconsin-Madison School of Nursing, University of Wisconsin, 701 Highland Ave. Madison, WI, WI 53705, Madison, USA. jane.harneyralphe@wisc.edu.
Insights
Hypothermia in very low birth weight (VLBW) infants is linked to acute respiratory issues like desaturations and increased oxygen needs. Further research is needed to confirm if temperature management can improve respiratory outcomes in these vulnerable infants.
Area of Science:
- Neonatal intensive care
- Pediatric respiratory medicine
- Thermoregulation in infants
Background:
- Thermal instability in very low birth weight (VLBW) infants admitted to the NICU is linked to respiratory problems.
- The relationship between persistent thermal instability and ongoing respiratory morbidity in VLBW infants is not well understood.
Purpose of the Study:
- To investigate the association between body temperature fluctuations in the first 14 days of life and acute and chronic respiratory morbidities in VLBW infants.
- To determine if hypothermia or hyperthermia impacts the risk or severity of respiratory complications.
Main Methods:
- Longitudinal data analysis of 12 VLBW infants.
- Defined chronic respiratory morbidity risk by oxygen or diuretic use at 36 weeks postmenstrual age.
- Quantified acute respiratory morbidity through desaturations, bradycardia, apnea, and changes in respiratory support.
- Utilized multi-level, mixed-effects models and regression analysis to examine temperature-respiratory morbidity relationships.
Main Results:
- No association was found between body temperature and chronic respiratory morbidity risk (p=0.2765).
- Episodes of hypothermia were significantly associated with increased risk of desaturations (aOR=1.3), bradycardia with desaturations (aOR=2.2), increased FiO2 requirement (aOR=1.2), and increased respiratory support (aOR=1.2).
- Apnea showed an association with increased body temperature (p<0.05).
Conclusions:
- VLBW infants require a neutral thermal environment for development.
- Significant associations between hypothermia and acute respiratory morbidity symptoms warrant further investigation.
- It remains unclear whether these associations are causal, suggesting potential for clinical practice changes, or if they represent concurrent symptoms of physiological instability.
Background:
Very low birth weight (VLBW) infant thermal instability upon neonatal intensive care unit admission has been associated with respiratory morbidity; however, the association between ongoing thermal instability and respiratory morbidity remains unclear.
Methods:
A longitudinal data analysis was conducted on 12 VLBW infants. Chronic respiratory morbidity risk was defined as supplemental oxygen requirement (FiO2) or scheduled diuretic dosing at 36 weeks post-menstrual age. Acute respiratory morbidity was quantified as desaturations (SpO2<90%), bradycardia with desaturations (HR<100 and SpO2<90%), apnea, increase in FiO2 requirement, or increase in respiratory support. Multi-level, mixed-effects models and regression analysis examined the relationships between body temperature over the first 14 days of life and respiratory morbidities.
Results:
Body temperature was not associated with chronic respiratory morbidity risk (p=0.2765). Desaturations, bradycardia with desaturations, increased FiO2 requirement, and increased respiratory support were associated with decreased body temperature (p<0.05). Apnea was associated with increased body temperature (p<0.05). The covariate-adjusted risk of desaturations (aOR=1.3), bradycardia with desaturations (aOR=2.2), increase in FiO2 requirement (aOR=1.2), and increase in respiratory support (aOR=1.2) were significantly greater during episodes of hypothermia.
Conclusion:
VLBW infants are dependent on a neutral thermal environment for optimal growth and development. Therefore, the significant associations between hypothermia and symptoms of acute respiratory morbidity require further study to delineate if these are causal relationships that could be attenuated with clinical practice changes, or if these are concurrent symptoms that cluster during episodes of physiological instability.
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