Body temperature instability and respiratory morbidity in the very low birth weight infant: a multiple case, intensive l
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RESEARCH ARTICLE
Open Access
Body temperature instability and respiratory morbidity in the very low birth weight infant: a multiple case, intensive longitudinal study Jane L. Ralphe1*, Susan G. Silva2,3, Robin B. Dail4 and Debra H. Brandon2,3
Abstract 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 37.2oC
Euthermia
Body temp 36.5oC to 37.2oC
Hypothermic episode Begins when body temp < 36.5oC & ends when body temp ≥ 36.5oC (in min) Hyperthermic episode Begins when body temp < 37.2oC & ends when body temp ≥ 37.2oC (in min) Acute Respiratory Morbidity Desaturation
SpO2 < 90%
Brady/Desaturation
Heart rate < 100 & SpO2 < 90%
Apnea
Time of apnea plus 15 min prior & 5 min after
FiO2 increase
Time of FiO2 increase plus 15 min prior to & 5 min after
RS increase
Time of PIP, PEEP, or RR increase plus 15 min prior to & 5 min after
Chronic Respiratory Morbidity CRMR
Diagnosis of BPD or SD
BPD
FiO2 > 21% at 28 DOL or 36 weeks PMA
SD
No diagnosis of BPD, but receiving scheduled diuretic dosing for respiratory symptoms at 36 weeks PMA
Covariates Chorioamnionitis
Maternal diagnosis of chorioamnionitis
GA
Gestational age at birth in weeks
Birthweight
Birthweight in grams
SGA
Birthweight < 10th percentile on growth curve
Sex
Female or Male
Apgar Scores
Apgar score at 1 & 5 minutes
Surfactant
Received at least one dose of surfactant
Infection
Sepsis or presumed sepsis during the first 14 DOL
temp temperature; FiO2 fraction of inspired air; SpO2 peripheral capillary oxygen saturation; min minute; RS respiratory support; BPD bronchopulmonary dysplasia; SD scheduled diuretics dosing; CRMR chronic respirtory morbidity risk; DOL days of life; PMA postmenstrual age; GA gestational age; SGA small for gestational age; IUGR intrauterine growth restriction
(PDA). See Table 1 for analysis variables and their definitions. Abdominal temperature, HR, SpO2, and EHR data for each infant were concatenated and archived in a SAS case dataset (one dataset per infant) using ®SAS statistical software version 9.4 (Cary, NC). The 12 infant datasets were then merged into a final analysis dataset. Analysis variables in this final dataset included measures of body temperature, biomarkers for acute respiratory morbidity, chronic respiratory morbidity risk, and covariates.
Ralphe et al. BMC Pediatrics
(2020) 20:485
The covariates SGA and IUGR were combined into a single covariate during analysis as infants with IUGR in this study also met criteria for SGA (i.e., BW < 10% on growth curve).
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temperature across days
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