385 - Association of Neonatal Outcomes with Admission Hypothermia among Very Preterm Infants in Chinese Neonatal Intensive Care Units: A Retrospective Multicenter Cohort Study

Poster Number: 385
Publication Number: 385.134

Wenchao Hong, Shanghai children‘s hospital, Shanghai, Shanghai, China (People's Republic); Yanping Zhu, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (People's Republic); Mingxia Li, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (People's Republic); Jianhua Sun, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai, China (People's Republic); Yuan Shi, Children's Hospital of Chongqing Medical University, Chongqing, Chongqing, China (People's Republic); Yanchen Wang, Children‘s Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Xiaohui Gong, Shanghai Children's Hospital, Shanghai, Shanghai, China (People's Republic)

Background: Admission hypothermia (AH) of very preterm infants (VPIs) remains a global issue and, if prolonged, is associated with increased mortality and morbidity. However, the incidence of AH and related factors among Chinese VPIs is not well documented.

Objective: To investigate the incidence of AH and association with neonatal outcomes among VPIs in Chinese neonatal intensive care units (NICU).

Design/Methods: This is a retrospective cohort study using the Chinese Neonatal Network (CHNN) database comprising 57 tertiary hospitals from 25 provinces in China. The infants admitted to NICU with gestational age < 32+0 weeks and body temperature ≤37.5℃ at admission were included during January 1st and December 31st, 2019. The VPIs were divided into four groups according to admission temperature, < 35.5℃, 35.5℃~35.9℃，36.0℃~36.4℃, 36.5℃~37.5℃ (normothermia group). Association between body temperature at admission and in-hospital mortality and morbidity were analyzed by logistic regression. Analysis was adjusted based on maternal and neonatal characteristics.

Results: A total of 5913 VPIs were included in this study, of which 4075 infants (68.9%) were included in the hypothermia groups ( < 36.5℃). The incidence of AH varies greatly among the 57 CHNN sites (9–100%) . AH was significantly related to lower gestational age, antenatal steroid usage, multiple birth, smaller than gestational age (SGA), Apgar score < 7 at 5th minute and intensive resuscitation. The composite outcome of mortality and major morbidity were associated with AH. AH ＜35.5℃ was significantly associated with higher odds of composite outcome (adjusted odds ratio [AOR] 1.47, 95%CI 1.15-1.88), short-term composite outcome (AOR 1.45, 95%CI 1.04-2.02) and RDS (AOR 1.44, 95%CI 1.03-2.00). Both groups with AH 36.0℃~36.4℃ and < 35.5℃ were significantly associated with higher odds of mortality (AOR 1.41, 95%CI 1.09-1.83, AOR 1.93, 95%CI 1.31-2.85) and early death (AOR 1.53 95%CI 1.11-2.11, AOR 2.21 95%CI 1.35-3.60). All the AH groups were significantly associated with higher odds of severe BPD respectively (AOR 1.25, 95%CI 1.09-1.43, AOR 1.41, 95%CI 1.11-1.79, AOR 1.99, 95%CI 1.60-2.47). Both groups with AH 35.5℃~35.9℃ and < 35.5℃ were associated with higher length of hospital stay (AOR 1.03, 95%CI 1.00-1.06; AOR 1.07 95% 1.04-1.11) .Conclusion(s): Admission hypothermia remains a common problem in VPIs in the Chinese large cohort, and it is associated with significantly higher morbidity and mortality.
Table 1 Baseline description, maternal and infant characteristics of study population in the CHNN cohort
Figure 1 Distribution of infant body temperature at admission to neonatal intensive care unit by site