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The Association Between Very Premature Infant Body Temperatures Over Time and Respiratory Care
Jane L Ralphe1, Susan G Silva2,3, Robin B Dail4
1School of Nursing, 5228University of Wisconsin-Madison, WI, USA.
Insights
Respiratory support and care events impact thermal stability in very low birthweight (VLBW) infants. Mechanical ventilation and certain care interventions increase hypothermia risk, highlighting the need for further research.
Area of Science:
- Neonatal physiology
- Infant thermal regulation
- Clinical care interventions
Background:
- Very low birthweight (VLBW) infants (<1,500 g) require significant thermal and respiratory support due to physiological immaturity.
- The precise impact of various respiratory care strategies on the thermal stability of VLBW infants remains incompletely understood.
Purpose of the Study:
- To investigate the association between body temperatures of VLBW infants over the first five days of life and their respiratory support.
- To examine the influence of specific respiratory care interventions and nursing care events on infant thermal stability.
Main Methods:
- Utilized an exploratory, longitudinal, and correlational design with minute-to-minute body temperature and continuous video data from 12 VLBW infants (<29 weeks gestation).
- Respiratory support data was extracted from electronic health records, and video data was coded using Noldus Observer®XT.
- Hierarchical multi-level, mixed-effects models were employed to analyze intensive longitudinal data.
Main Results:
- Significant associations were found between infant body temperatures and respiratory support type, respiratory care interventions, and care events (all p < .0001).
- Pairwise comparisons revealed significant temperature differences across all respiratory support types (mechanical ventilation, CPAP, room air).
- The risk of hypothermia was notably higher during mechanical ventilation compared to room air (aOR = 2.6) and during care events versus closed portholes (aOR = 2.6).
Conclusions:
- VLBW infant thermal instability is linked to the type of respiratory support, respiratory care practices, and specific care events.
- Further research with larger cohorts and advanced longitudinal analyses is crucial to establish causality and understand the long-term effects of thermal instability on infant outcomes.
Background:
Due to global immaturity, very low birthweight (VLBW) infants (<1,500 g) require auxiliary thermal and respiratory care. However, the impact of respiratory care on infant thermal stability remains unclear.
Aims:
Examine the association between VLBW infant body temperatures over time and respiratory support type (mechanical ventilation (MV), continuous positive airway pressure (CPAP), room air (RA)), respiratory care interventions, and nursing care.
Design:
Exploratory, longitudinal, and correlational design.
Subjects:
12 infants <29 weeks' gestation (median = 27.1, 25.9-27.9) and <1,200 g (median = 865 g, 660-1,050 g).
Measurements:
Minute-to-minute body temperatures and continuous video data were collected over the first 5 days of life. Video data was coded with Noldus Observer®XT software. Respiratory support was retrieved from the electronic health record. Hierarchical multi-level, mixed-effects models for intensive longitudinal data examined the associations.
Results:
Body temperatures were associated with respiratory support type, respiratory care, and care events (all p < .0001). Pairwise comparison found significant differences in body temperatures between all respiratory support types (all p < .0001). The covariate-adjusted risk of hypothermia (<36.5 °C) was significantly greater during MV vs. RA (aOR = 2.6); CPAP vs. MV (aOR = 1.2); CPAP vs RA (aOR = 3.1); respiratory care vs. other types of care (aOR = 1.5); care event vs. closed portholes (aOR = 2.6).
Conclusion:
Our results found an association between VLBW infant thermal instability and respiratory support type, respiratory care, and care events. Larger studies with advanced longitudinal analysis are needed to assess the causal impact of these interventions on infant temperatures over time, as well as the implications of longitudinal thermal instability on infant outcomes.
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