ORIGINAL ARTICLE Child Health Nurs Res, Vol.23, No.4, October 2017: ISSN(Print) ISSN(Onli

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1 ORIGINAL ARTICLE ISSN(Print) ISSN(Online) 안영미, 손민, 김남희, 강나래, 강승연, 정은미 인하대학교의과대학간호학과 Hypothermia and Related Factors in High-Risk Infants Youngmee Ahn, Min Sohn, Namhee Kim, Narae Kang, Seungyeon Kang, Eunmi Jung Department of Nursing, College of Medicine, Inha University, Incheon, Korea Purpose: Maintaining body temperature is a key vital function of human beings, but little is known about how body temperature of highrisk infants is sustained during early life after birth. The aim of this study was to describe hypothermia in high-risk infants during their first week of life and examine demographic, environmental, and clinical attributors of hypothermia. Methods: A retrospective longitudinal study was done from January 1, 2013 to December 31, Medical records of 570 high-risk infants hospitalized at Neonatal Intensive Care Units (NICU) of a university affiliated hospital were examined. Body temperature and related were assessed for seven days after birth. Results: A total of 336 events of hypothermia (212 mild and 124 moderate) occurred in 280 neonates (49.1%) and most events (84.5%) occurred within 24 hours after birth. Logistic regression analysis revealed that phototherapy (aor=0.28, 95% CI= ), Apgar score at 5 minute (aor=2.20, 95% CI= ), and intra-uterine growth retardation or small for gestational age (aor=3.58, 95% CI= ) were statistically significant contributors to hypothermia. Conclusion: Findings indicate that high-risk infants are at risk for hypothermia even when in the NICU. More advanced nursing interventions are necessary to prevent hypothermia of high-risk infants. Key words: Hypothermia, Newborns, Neonatal intensive care units Corresponding author Namhee Kim Department of Nursing, College of Medicine, Inha University, 100 Inharo, Nam-gu, Incheon 22212, Korea TEL FAX knh@inha.ac.kr * 2015 ( ) (. 2015R1D1A1A ). * This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (. 2015R1D1A1A ). Key words,, Received 25 August 2017 Received in revised form 6 October 2017 Accepted 18 October 2017 서 론 연구의필요성. This is an Open Access article distributed under the terms of the Creative Commons Attribution n- Commercial License ( which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited., [1].. [2], (World Health Organization, WHO) (36.0~36.4 ), (32.0~35.9 ), (32.0 ) [2]. 32% 85% [3]. 35.5~36.5, 37.0~37.9 [4]., 36.5~37.1 [1], [5-7] Copyright 2017 Korean Academy of Child Health Nursing 505

2 , [2,8].. [1,9]. [9]. [8,10]. (intraventricular hemorrhage), [8,11]., (Low Birth Weight, LBW). LBW, [1,12].,,, x-ray,., [9]. (Very Low Birth Weight, VLBW) 50% [11] (body index). LBW 36.5, 1 28% (late-onset sepsis) 11% [5].,,, 5 [5,8].., [13,14]. (neutral thermal environment) [1,9,13], 28 VLBW [9,15]. (Neonatal Intensive Care Units, NICU),, [13,14]. LBW [1,13]. 3~7 70% [1,13]. [16], [17], [18], [19], [10]. LBW,, [5,7,8], LBW [15], skin-to-skin care[20], trans-warmer [21].,..,.. NICU,,. 연구목적.,.,,,.,. 연구방법 연구설계 NICU. 연구대상 NICU

3 3,. 3,, , SPSS 22.0,.,,, T,,.. 자료수집방법 ( : A) NICU [1].,. (frequency), (degree), (time). 1 (event 1). (event). WHO 36.5 [2], (Microlife electronic thermometer MT200, ONBO Electronic Co., Ltd., China) ± ~36.3 (mild hypothermia), 32.0~35.9 (moderate hypothermia), 32.0 (severe hypothermia)..,,,,,.,. 자료분석방법 NICU 579, 3 9, 연구결과 (47.1%), 166 (59.3%), ± 3.99, ± gram ± 2.03, 256 (91.4%). (81.4%), (23.6%), / (15.7%), (Intra-Uterine Growth Retardation/Small for Gestational Age, IUGR/SGA, 14.6%). 6 (2.1%), 71 (25.4%). (84.6%), (10.0%), (5.4%). 저체온증의양상 , , (63.1%), 124 (36.9%),. 33.6~36.3, ± Figure %, 84.5% %, 58.9% 20. 저체온증과관련요인,, (Table 1),,,,,,,.,, 5 7, IUGR/SGA ( : χ 2 = 6.17, p =.020; : χ 2 = 6.03, p =.015; 5 : χ 2 = 4.22, p=.049; IUGR/SGA: χ 2 =13.15, p<.001). 안영미, 손민, 김남희외 3 인 507

4 Figure 1. Frequency of hypothermia in high-risk infants during the first week of life.,, (Table 2),,,.,,,,, 5, IUGR/SGA. 1,000 gram (Extremely Low Birth Weight, ELBW) 1,000 gram (35.72 ± ± 0.46 ; t =7.36, p=.007) , (35.75 ± 0.59, 35.77± ± 0.38 ; F = 4.22, p=.006). (35.84 ± ± 0.43 ; t = 4.97, p=.026), (35.77 ± ± 0.42 ; t = 8.75, p =.003), 5 7 (35.79 ± ± 0.43 ; t = 6.65, p =.010), IUGR/SGA (35.72 ± ± 0.47 ; t =7.08, p =.008), (36.12 ± ± 0.49 ; t= 8.83, p=.003), %,, 5, (Table 3)., ( : r=.17, p=.004; : r =.17, p =.005; 5 : r=.22, p <.001; : r=.14, p=.044)., ELBW (r =.66, p<.001)

5 Table 1. Comparison of Frequencies in Severity of Hypothermia by Characteristics of High-Risk Infants during the First Week of Life (N=336) Variables Characteristics Categories Mild (n=212) Hypothermia: n (%) Moderate (n=124) χ 2 (p) Demographic Gender Female Male 93 (60.0) 119 (65.7) 62 (40.0) 62 (34.3) 155 (46.1) 181 (53.9) 1.18 (.308) Birth weight (gram) 1,000 <1, (64.8) 26 (53.1) 101 (35.2) 23 (46.9) 287 (85.4) 49 (14.6) 2.48 (.149) Gestational age (week) 37 <37 26 (48.1) 186 (66.0) 28 (51.9) 96 (34.0) 54 (16.1) 282 (83.9) 6.17 (.020) Environmental Type of delivery NSD C/sec 97 (68.8) 115 (59.0) 44 (31.2) 80 (41.0) 141 (42.0) 195 (58.0) 3.39 (.068) Placement* Incubator Radiant warmer 180 (63.6) 18 (51.4) 103 (36.4) 17 (48.6) 283 (89.0) 35 (11.0) 1.97 (.196) Phototherapy 184 (60.9) 28 (82.4) 118 (39.1) 6 (17.6) 302 (89.9) 34 (10.1) 6.03 (.015) Artificial ventilator 157 (65.1) 55 (57.9) 84 (34.9) 40 (42.1) 241 (71.7) 95 (28.3) 1.54 (.258) Clinical features Apgar score at 5 min 7 <7 156 (66.7) 56 (54.9) 78 (33.3) 46 (45.1) 234 (69.6) 102 (30.4) 4.22 (.049) Health problems at birth 11 (44.0) 201 (64.6) 14 (56.0) 110 (35.4) 25 (7.4) 311 (92.6) 4.23 (.052) IUGR/SGA 194 (66.9) 18 (39.1) 96 (33.1) 28 (60.9) *Bassinet was excluded; NSD=rmal spontaneous delivery; IUGR=Intra-uterine growth retardation; SGA=Small for gestational age. 290 (86.3) 46 (13.7) (<.001) 저체온증에영향을미치는요인,, Table 4. Adjusted odds ratio,,,,,, (aor =2.20; 95% CI = ; p=.014), IUGR/SGA 3.58 (aor =3.58; 95% CI = ; p =.001). 72% (aor = 0.28; 95% CI = 0.10~0.78; p=.015). 논의,...,,. 3 NICU.., (,, ) %, 52.7%[19], 56.2%[8], 44~51%[22]. NICU.. 안영미, 손민, 김남희외 3 인 509

6 Table 2. Comparison of Body Temperature at Hypothermia Events by Characteristics of High-risk Infants during the First Week of Life (N=336) Variables Characteristics Categories n Demographic Gender Female Male Body temperature ( ) M±SD 35.88± ±0.52 t or F (p) 0.13 (.717) Birth weight (gram) 1,000 <1, ± ± (.007) Gestational age (week) <28 a 28, <32 b 32, <37 c 37 d ± ± ± ± (.006) a, d<c Environmental Type of delivery NSD C/sec ± ± (.026) Placement* Incubator Radiant warmer ± ± (.186) Phototherapy ± ± (.003) Artificial ventilator ± ± (.003) Clinical features Apgar score at 5 min 7 < ± ± (.010) Health problems at birth ± ± (.098) IUGR/SGA ± ± (.008) *Bassinet was excluded; Tukey HSD analysis; NSD=rmal spontaneous delivery; IUGR=Intra-uterine growth retardation; SGA=Small for gestational age. 63.1%, 36.9%. 67.3%, 32.7%, [11]. 40%. Miller, Lee Gould VLBW [8]., [11].,,,, [14] %, % %. NICU %, 72 (early hypothermia) 67.6%, 72 (late hypothermia) 46.2% 72 [23]., 1, 3,,. NICU, 40%. NICU,

7 Table 3. Correlation of Hypothermia and Related Factors at First Day after Birth Variables Categories n Birth weight (gram) <1,000 1,000, <1,500 1,500, <2,500 2, Mild (n=164) Hypothermia Moderate (n=115) r (p) r (p) r (p).18 (.495) -.10 (.622) -.07 (.539).14 (.420).12 (.121).60 (.004) -.11 (.659).09 (.547) -.32 (.140).22 * (.020).66 (<.001) -.18 (.257).07 (.434) -.20 (.122).17 (.004) (N=279) Gestational age (week) <28 28, <32 32, < (.632) -.05 (.764) -.06 (.577).14 (.515).04 (.623).54 (.008).50 * (.019) -.04 (.791).44 * (.023).27 (.003).43 (.006).20 (.125) -.12 (.162).39 (.004).17 (.005) Apgar score at 5 min < * (.025).11 (.220).09 (.250).12 (.454).04 (.756).22 * (.017).21 (.058) -.03 (.669).22 (<.001) SpO2 (%) < (.593).20 (.186) -.02 (.836).36 * (.010).02 (.907).23 * (.039).25 (.006) -.02 (.889).14 * (.044) * p <.05, p <.01; SpO2=Saturation of peripheral oxygen. Table 4. Logistic Regression Analysis to Predict Occurrence of Moderate Hypothermia according to Demographic, Environmental and Clinical Variables (N=336) Variables Characteristics Categories Crude OR [95% CI] Adjusted OR [95% CI] Demographic Gender Female Male 0.78 [0.50~1.22] 0.91 [0.55~1.51] Birth weight (gram) 1,000 <1, [0.88~3.00] 1.58 [0.70~3.54] Gestational age (week) 37 < [0.27~0.86] 0.51 [0.19~1.34] Environmental Type of delivery NSD C/sec 1.53 [0.97~2.42] 1.12 [0.66~1.88] Placement* Incubator Radiant warmer 1.65 [0.82~3.34] 1.44 [0.67~3.08] Phototherapy 0.33 [0.13~0.83] 0.28 [0.10~0.78] Artificial ventilator 1.36 [0.84~2.21] 1.18 [0.57~2.45] Clinical features Apgar score at 5 min 7 < [1.02~2.64] 2.20 [1.17~4.12] Health problems at birth 0.43 [0.19~0.98] 0.43 [0.11~1.59] IUGR/SGA 3.14 [1.66~5.97] 3.58 [1.69~7.58] *Bassinet was excluded; OR=Odds ratio; CI=Confidence interval; NSD=rmal spontaneous delivery; IUGR=Intra-uterine growth retardation; SGA=Small for gestational age. 안영미, 손민, 김남희외 3 인 511

8 , 15% 24.,. ELBW 28.. ELBW, [1,9,12]. NICU.. VLBW ELBW,, skin-to-skin, trans-warmer [9,15,20,21], NICU ± ± NICU. LBW [8-10,12,13]. NICU..,,.,. 72%... [24] [25],., [8,26].. [9,27]., NICU. NICU., 5 IUGR/ SGA. 5 7,. 5, [8,26]. 5 4 [28]. 5,,,. IUGR/SGA,. IUGR/SGA IUGR 6% 10% IUGR [30]. IUGR/SGA [29].,, [1] IUGR/SGA

9 ELBW IUGR/SGA,. NICU,. NICU NICU.,,,..,,.., 3 NICU... 결론, % ,,,, 5, IUGR/SGA... Conflict of Interest potential or any existing conflict of interest relevant to this article was reported. Acknowledgments This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (. 2015R1D1A1A ). References 1. The Korean Society of Neonatology. Manual of neonatal care. 3rd ed. Seoul: The Korean Society of Neonatology; p World Health Organization. Thermal protection of the newborn: A practical guide [Internet]. World Health Organization; 1997 [cited 2016 April 15]. Available from: 3. Lunze K, Bloom DE, Jamison DT, Hamer DH. The global burden of neonatal hypothermia: Systematic review of a major challenge for newborn survival. BMC Medicine. 2013;11(24): Takayama JI, Teng W, Uyemoto J, Newman TB, Pantell RH. Body temperature of newborns: What is normal? Clinical Pediatrics. 2000;39(9): Laptook AR, Salhab W, Bhaskar B, Neonatal Research Network. Admission temperature of low birth weight infants: Predictors and associated morbidities. Pediatrics. 2007;119(3):e643-e McCall EM, Alderdice F, Halliday HL, Jenkins JG, Vohra S. Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. The Cochrane Database of Systematic Reviews. 2010; 17(3):CD Bissinger RL, Annibale DJ. Thermoregulation in very low-birthweight infants during the golden hour: Results and implications. Advances in Neonatal Care. 2010;10(5): Miller SS, Lee HC, Gould JB. Hypothermia in very low birth weight infants: Distribution, risk and outcomes. Journal of Perinatology. 2011;31(Suppl 1):S49-S 안영미, 손민, 김남희외 3 인 513

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386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon