Study: Hypothermia more likely in Black, Asian newborns

(Press-News.org) Newborns of Black and Asian mothers are significantly more likely to experience hypothermia than those born to white mothers, according to a new study. The research will be presented at the Pediatric Academic Societies (PAS) 2023 Meeting, held April 27-May 1 in Washington, D.C.

Researchers reviewed electronic medical records of 23,549 infants born at 35 weeks or later and admitted to a children’s hospital-affiliated newborn nursery between 2015 and 2021. The study evaluated all recorded temperatures of hospitalized newborns and classified cases of hypothermia—a condition in which body temperature drops below 97.7°F—as mild (one episode of temperature 96.8-97.5°F) or moderate/severe (two or more episodes of temperature less than 97.7°F and/or one or more episodes of temperature 96.8°F or less).

The study found one in five (21.7%) newborns were hypothermic and 21.4% of these were classified as moderate/severe. When compared to white mothers, newborns of Black and Asian mothers had significantly higher odds of mild hypothermia and even higher odds of severe hypothermia.

Both mild and moderate/severe hypothermia were more likely in newborns of lower gestational age, lower weight, and who were both bottle and breastfed. Hypothermia was less likely in newborns born in the late afternoon. Hypothermia in newborns can be caused by environmental factors or can be a sign of illness, like sepsis.

“Hypothermia doesn’t only happen in very low weight or premature newborns, but our data and approach to treatment are limited to that population,” said Rebecca Dang, M.D., M.S.Epi, Instructor at Lucile Packard Children’s Hospital at Stanford and presenting author. “Understanding how and why newborns of all gestational ages and sizes experience hypothermia will allow us to provide better, tailored care and address racial disparities made clear by this study.”

Study authors note identifying factors that affect hypothermia is critical to targeting evidence-based hypothermia care efforts toward at-risk newborns.

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EDITOR:
Dr. Dang will present “Incidence and Patient Factors Associated with Neonatal Hypothermia in Late Preterm and Term Infants” on Saturday, April 29 at 8 a.m. ET.
Reporters interested in an interview with Dr. Dang should contact Amber Fraley at amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting is the premier North American scholarly child health meeting. The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit www.pas-meeting.org. Follow us on Twitter @PASMeeting and like us on Facebook PASMeeting.

Abstract

Incidence and patient factors associated with neonatal hypothermia in late preterm and term infants

Presenting Author

Rebecca Dang, M.D.

Organization

Lucile Packard Children's Hospital Stanford

Topic

General Pediatrics: All Areas

Background

Thermoregulation is a central component of newborn care, driving frequent measurements in newborn nurseries the first days after birth. Detection of hypothermia (WHO definition < 36.5˚C) often prompts thermoregulatory interventions and can lead to diagnostic testing and even escalation of care (i.e. concern for sepsis). Much of our understanding and approach to hypothermia is driven by data in extremely premature and very low birth weight infants. However, the prevalence and characteristics associated with hypothermia in well newborns are less understood. 

Objective

Determine the incidence and characteristics associated with hypothermia detection in the newborn nursery.

Design/Methods

Retrospective cohort study (2015-2021) using electronic medical record data on infants ≥35 weeks-gestation admitted to a children’s hospital-affiliated newborn nursery. All temperatures during the hospitalization, apart from those measured in the delivery room, were evaluated. For the primary analysis, infants were classified as having mild (single episode, 36.0-36.4˚C) or severe (≥2 episodes < 36.5˚C and/or ≥1 episode ≤35.9˚C) hypothermia. Secondarily, infants with only early (< 24 hours of life) vs late (any episode extending beyond 24 hours) hypothermia timing were also compared. Multinomial logistic regression examined associations between patient-level characteristics and hypothermia detection.

Results

At least one episode of hypothermia was detected in 21.7% (5,114/23,549) of infants (Table 1). Of those hypothermic, 21.4% (1,094/5,114) were classified as severe and 8.1% (416/5,114) as late. When compared to infants born to White mothers, infants born to Black (aOR 1.8, 95% CI 1.49-2.33) and Asian (aOR 1.46, 95% CI 1.33-1.60) mothers had significantly higher odds of mild hypothermia, with even higher odds for severe hypothermia (aOR 2.32, 95% CI 1.57-3.44; aOR 1.79, 95% CI 1.50-2.13, respectively). Non-primiparous status was protective for severe (aOR 0.82, 95% CI 0.72-0.94) and late (aOR 0.66, 95% CI 0.53-0.83) hypothermia. All classifications of hypothermia were more common in infants of lower gestational age, lower birth weight, and who had a mix of breast and bottle feeding but less common in infants born in the late afternoon (Figures 1 & 2).

Conclusion(s)

Hypothermia is detected in 1 of 5 infants in the newborn nursery. Identifying factors that influence hypothermia detection in well newborns is critical for targeting thermoregulatory and temperature measurement efforts toward at risk infants.

Tables and Images

Figure 1.PNG

Figure 2.PNG

Table 1.PNG

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