Impact of the Transition of Neonatal Body Temperature from Resuscitation to Admission on Prematurity Complications: A Retrospective Observational Study

Abstract

Objective

This study aimed to investigate the correlation between body temperature change from postbirth resuscitation (Tr) to admission (Ta), the impact of the transition of Tr to Ta, and the rate of Ta normalization on prematurity-related complications.

Study Design

A single-center retrospective observational study was conducted on inborn infants < 33 weeks gestational age, born between January 1, 2017, and May 31, 2021. Linear regression and multivariate logistic regression were used to evaluate the Tr-Ta relationship and to assess other associations. Normal body temperature was 36.5 to 37.5°C.

Results

From 568 eligible infants, 517 (91%) had both Tr and Ta records. Of these, 336/517 (65.0%) had normal Ta. And 80/336 infants (23.8%) with normal Ta had preceding abnormal Tr. Tr and Ta had a positive linear correlation (R ² = 0.23, p < 0.01). After adjusting for birth-to-NICU-admission time and perinatal factors, Tr hypothermia was associated with bronchopulmonary dysplasia (BPD; adjusted odds ratio [aOR]: 2.14, 95% confidence interval [CI]: 1.26–3.65, p < 0.01) and Ta hypothermia was associated with death before discharge (aOR: 2.98, 95% CI: 1.18–7.53, p = 0.02). Infants experiencing hypothermia during Tr to Ta transition were at a higher risk for periventricular leukomalacia (PVL), specifically, transition from Tr hypothermia to Ta normothermia/hyperthermia (aOR: 5.35, CI: 1.27–22.53, p = 0.02) and Tr hypothermia to Ta hypothermia (aOR: 4.72, CI: 1.13–19.79, p = 0.03). Transitioning from Tr hypothermia to Ta hypothermia was associated with a higher incidence of BPD (aOR: 1.84, 95% CI: 0.91–3.73, p = 0.09) and death (aOR: 2.96, 95% CI: 0.89–9.91, p = 0.08), though not statistically significant. Ta normalization at a rate of ≥0.5°C/hour was associated with a reduced risk of developing BPD.

Conclusion

Hypothermia during Tr-to-Ta transition was associated with an increased risk of PVL. Future research should explore the effects of abnormal temperature duration and magnitude on neonatal outcomes.

Key Points

• Impact of neonatal temperature transition on prematurity outcomes.

• Importance of early and continuous temperature monitoring.

• Hypothermia resulted in a higher chance of developing PVL.

Keywords

postresuscitation temperature - admission temperature - preterm - complications - mortality

Publication History

Received: 12 September 2024

Accepted: 04 April 2025

Article published online:
30 April 2025

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