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Dimitrova A, Dimitrova A, Mengel M, Gasparrini A, Lotze-Campen H, Gabrysch S. Temperature-related neonatal deaths attributable to climate change in 29 low- and middle-income countries. Nat Commun 2024; 15:5504. [PMID: 38951496 PMCID: PMC11217431 DOI: 10.1038/s41467-024-49890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 06/19/2024] [Indexed: 07/03/2024] Open
Abstract
Exposure to high and low ambient temperatures increases the risk of neonatal mortality, but the contribution of climate change to temperature-related neonatal deaths is unknown. We use Demographic and Health Survey (DHS) data (n = 40,073) from 29 low- and middle-income countries to estimate the temperature-related burden of neonatal deaths between 2001 and 2019 that is attributable to climate change. We find that across all countries, 4.3% of neonatal deaths were associated with non-optimal temperatures. Climate change was responsible for 32% (range: 19-79%) of heat-related neonatal deaths, while reducing the respective cold-related burden by 30% (range: 10-63%). Climate change has impacted temperature-related neonatal deaths in all study countries, with most pronounced climate-induced losses from increased heat and gains from decreased cold observed in countries in sub-Saharan Africa. Future increases in global mean temperatures are expected to exacerbate the heat-related burden, which calls for ambitious mitigation and adaptation measures to safeguard the health of newborns.
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Affiliation(s)
- Asya Dimitrova
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany.
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Anna Dimitrova
- Scripps Institution of Oceanography, University of California, San Diego, CA, 92037, USA
| | - Matthias Mengel
- Research Department 3, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Antonio Gasparrini
- Environment & Health Modelling (EHM) Lab, Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Hermann Lotze-Campen
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- Department of Agricultural Economics, Faculty of Life Sciences, Humboldt University of Berlin, Berlin, Germany
| | - Sabine Gabrysch
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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2
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Dunne EA, O'Donnell CPF, Nakstad B, McCarthy LK. Thermoregulation for very preterm infants in the delivery room: a narrative review. Pediatr Res 2024; 95:1448-1454. [PMID: 38253875 PMCID: PMC11126394 DOI: 10.1038/s41390-023-02902-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/28/2023] [Accepted: 11/02/2023] [Indexed: 01/24/2024]
Abstract
Abnormal temperature in preterm infants is associated with increased morbidity and mortality. Infants born prematurely are at risk of abnormal temperature immediately after birth in the delivery room (DR). The World Health Organization (WHO) recommends that the temperature of newly born infants is maintained between 36.5-37.5oC after birth. When caring for very preterm infants, the International Liaison Committee on Resuscitation (ILCOR) recommends using a combination of interventions to prevent heat loss. While hypothermia remains prevalent, efforts to prevent it have increased the incidence of hyperthermia, which may also be harmful. Delayed cord clamping (DCC) for preterm infants has been recommended by ILCOR since 2015. Little is known about the effect of timing of DCC on temperature, nor have there been specific recommendations for thermal care before DCC. This review article focuses on the current evidence and recommendations for thermal care in the DR, and considers thermoregulation in the context of emerging interventions and future research directions. IMPACT: Abnormal temperature is common amongst very preterm infants after birth, and is an independent risk factor for mortality. The current guidelines recommend a combination of interventions to prevent heat loss after birth. Despite this, abnormal temperature is still a problem, across all climates and economies. New and emerging delivery room practice (i.e., delayed cord clamping, mobile resuscitation trolleys, early skin to skin care) may have an effect on infant temperature. This article reviews the current evidence and recommendations, and considers future research directions.
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Affiliation(s)
- Emma A Dunne
- Department of Neonatology, The National Maternity Hospital, Holles Street, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Colm P F O'Donnell
- Department of Neonatology, The National Maternity Hospital, Holles Street, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Britt Nakstad
- Division of Pediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Lisa K McCarthy
- Department of Neonatology, The National Maternity Hospital, Holles Street, Dublin, Ireland.
- School of Medicine, University College Dublin, Dublin, Ireland.
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Rossi E, Maziku DM, Leluko DE, Guadagno C, Brasili L, Azzimonti G, Putoto G, Pietravalle A, Cavallin F, Trevisanuto D. Rewarming rate of hypothermic neonates in a low-resource setting: a retrospective single-center study. Front Pediatr 2023; 11:1113897. [PMID: 37228438 PMCID: PMC10203202 DOI: 10.3389/fped.2023.1113897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Background Hypothermic neonates need to be promptly rewarmed but there is no strong evidence to support a rapid or a slow pace of rewarming. This study aimed to investigate the rewarming rate and its associations with clinical outcomes in hypothermic neonates born in a low-resource setting. Methods This retrospective study evaluated the rewarming rate of hypothermic inborn neonates admitted to the Special Care Unit of Tosamaganga Hospital (Tanzania) in 2019-2020. The rewarming rate was calculated as the difference between the first normothermic value (36.5-37.5°C) and the admission temperature, divided by the time elapsed. Neurodevelopmental status at 1 month of age was assessed using the Hammersmith Neonatal Neurological Examination. Results Median rewarming rate was 0.22°C/h (IQR: 0.11-0.41) in 344/382 (90%) hypothermic inborn infants, and was inversely correlated to admission temperature (correlation coefficient -0.36, p < 0.001). Rewarming rate was not associated with hypoglycemia (p = 0.16), late onset sepsis (p = 0.10), jaundice (p = 0.85), respiratory distress (p = 0.83), seizures (p = 0.34), length of hospital stay (p = 0.22) or mortality (p = 0.17). In 102/307 survivors who returned at follow-up visit at 1 month of age, rewarming rate was not associated with a potential correlate of cerebral palsy risk. Conclusions Our findings did not show any significant association between rewarming rate and mortality, selected complications or abnormal neurologic exam suggestive of cerebral palsy. However, further prospective studies with strong methodological approach are required to provide conclusive evidence on this topic.
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Affiliation(s)
- Elisa Rossi
- Doctors with Africa CUAMM, Dar es Salaam, Tanzania
| | - Donald Micah Maziku
- Maternal and Child Department, Tosamaganga Council Designated Hospital, Ipamba, Tanzania
| | - Dionis Erasto Leluko
- Maternal and Child Department, Tosamaganga Council Designated Hospital, Ipamba, Tanzania
| | | | - Luca Brasili
- Doctors with Africa CUAMM, Dar es Salaam, Tanzania
| | | | - Giovanni Putoto
- Department of Research, Doctors with Africa CUAMM, Padova, Italy
| | | | | | - Daniele Trevisanuto
- Department of Woman’s and Child’s Health, University Hospital of Padova, Padova, Italy
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Muhindo MK, Bress J, Armas J, Danziger E, Wu A, Brewster RCL. The utilization of clinical decision support tools to identify neonatal hypothermia and its associated risk factors: A prospective observational study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000982. [PMID: 36962972 PMCID: PMC10022021 DOI: 10.1371/journal.pgph.0000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023]
Abstract
Hypothermia (axillary temperature less than 36.5°) is a major source of neonatal morbidity and mortality, with a disproportionate burden of disease in low- and middle-income countries. Despite the importance of thermoregulation on newborn outcomes, the global epidemiologic landscape of neonatal hypothermia is poorly characterized. Clinical decision support (CDS) software provides point-of-care recommendations to guide clinical management and may support data capture in settings with limited informatics infrastructure. Towards this end, we conducted a prospective observational study of the NoviGuide, a novel CDS platform for newborn care, at four health facilities in Uganda between September 2022 to May 2021. Data were extracted from clinical information (e.g. axillary temperature, birth weight, gestational age) entered into the NoviGuide by nurses and midwives on newborns within 24 hours of delivery. Descriptive statistics and multivariable logistic regression were used to evaluate neonatal temperature profiles and the association between hypothermia and clinical features. Among 1,027 completed assessments, 30.5% of entries had neonatal hypothermia with significant variation across study sites. On multivariable logistic regression analysis, we found that hypothermia was independently associated with pre-term birth (Adjusted Odd's Ratio [aOR] 2.62, 95% Confidence interval [CI] 1.38-4.98), sepsis/concern for sepsis (aOR 2.73, 95% CI 2.90-3.94), and hypoglycemia/concern for hypoglycemia (aOR 1.78, 95% CI 1.17-2.72). Altogether, neonatal hypothermia was commonly entered into the NoviGuide and associated clinical characteristics aligned with previous studies based on conventional data collection instruments. Our results should be contextualized within unique technical and operational features of CDS tools, including a bias towards acutely ill patients and limited quality control. Nonetheless, this study demonstrates that a CDS used voluntarily by clinicians has the potential to fill key data gaps and drive quality improvement towards reducing neonatal hypothermia in low resource settings.
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Affiliation(s)
| | - Joshua Bress
- Global Strategies, Albany, California, United States of America
| | - Jean Armas
- Global Strategies, Albany, California, United States of America
| | - Elon Danziger
- Global Strategies, Albany, California, United States of America
| | - Andrew Wu
- Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America
| | - Ryan C L Brewster
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, United States of America
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Shayo A, Mlay P, Ahn E, Kidanto H, Espiritu M, Perlman J. Early neonatal mortality is modulated by gestational age, birthweight and fetal heart rate abnormalities in the low resource setting in Tanzania - a five year review 2015-2019. BMC Pediatr 2022; 22:313. [PMID: 35624505 PMCID: PMC9137152 DOI: 10.1186/s12887-022-03385-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early Neonatal mortality (ENM) (< 7 days) remains a significant problem in low resource settings. Birth asphyxia (BA), prematurity and presumed infection contribute significantly to ENM. The study objectives were to determine: first, the overall ENM rate as well as yearly ENM rate (ENMR) from 2015 to 2019; second, the influence of decreasing GA (< 37 weeks) and BW (< 2500 g) on ENM; third, the contribution of intrapartum and delivery room factors and in particular fetal heart rate abnormalities (FHRT) to ENM; and fourth, the Fresh Still Birth Rates (FSB) rates over the same time period. METHODS Retrospective cohort study undertaken in a zonal referral teaching hospital located in Northern Tanzania. Labor and delivery room data were obtained from 2015 to 2019 and included BW, GA, fetal heart rate (FHRT) abnormalities, bag mask ventilation (BMV) during resuscitation, initial temperature, and antenatal steroids use. Abnormal outcome was ENM < 7 days. Analysis included t tests, odds ratios (OR), and multivariate regression analysis. RESULTS The overall early neonatal mortality rate (ENMR) was 18/1000 livebirths over the 5 years and did not change significantly comparing 2015 to 2019. Comparing year 2018 to 2019, the overall ENMR decreased significantly (OR 0.62; 95% confidence interval (CI) 0.45-0.85) as well as infants ≥37 weeks (OR 0.45) (CI 0.23-0.87) and infants < 37 weeks (OR 0.57) (CI 0.39-0.84). ENMR was significantly higher for newborns < 37 versus ≥37 weeks, OR 10.5 (p < 0.0001) and BW < 2500 versus ≥2500 g OR 9.9. For infants < 1000 g / < 28 weeks, the ENMR was ~ 588/1000 livebirths. Variables associated with ENM included BW - odds of death decreased by 0.55 for every 500 g increase in weight, by 0.89 for every week increase in GA, ENMR increased 6.8-fold with BMV, 2.6-fold with abnormal FHRT, 2.2-fold with no antenatal steroids (ANS), 2.6-fold with moderate hypothermia (all < 0.0001). The overall FSB rate was 14.7/1000 births and decreased significantly in 2019 when compared to 2015 i.e., 11.3 versus 17.3/1000 live births respectively (p = 0.02). CONCLUSION ENM rates were predominantly modulated by decreasing BW and GA, with smaller/ less mature newborns 10-fold more likely to die. ENM in term newborns was strongly associated with FHRT abnormalities and when coupled with respiratory depression and BMV suggests BA. In smaller newborns, lack of ACS exposure and moderate hypothermia were additional associated factors. A composite perinatal approach is essential to achieve a sustained reduction in ENMR.
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Affiliation(s)
- Aisa Shayo
- Department of Pediatrics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Pendo Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Emily Ahn
- Present address: Division of Newborn Medicine, Department of Pediatrics, Weill Cornell Medicine, New York Presbyterian Hospital, 1283 York Avenue, Box 106, New York, NY, 10065, USA
| | - Hussein Kidanto
- Department of Obstetrics and Gynecology, Aga Khan University, Dar Campus, Dar es Salaam, Tanzania
| | - Michael Espiritu
- Present address: Division of Newborn Medicine, Department of Pediatrics, Weill Cornell Medicine, New York Presbyterian Hospital, 1283 York Avenue, Box 106, New York, NY, 10065, USA
| | - Jeffrey Perlman
- Present address: Division of Newborn Medicine, Department of Pediatrics, Weill Cornell Medicine, New York Presbyterian Hospital, 1283 York Avenue, Box 106, New York, NY, 10065, USA.
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Relationship between Admission Temperature and Risk of Cerebral Palsy in Infants Admitted to Special Care Unit in a Low Resource Setting: A Retrospective Single-Center Study. CHILDREN 2022; 9:children9030352. [PMID: 35327724 PMCID: PMC8947039 DOI: 10.3390/children9030352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
Abstract
Background: Deviations from normothermia affect early mortality and morbidity, but the impact on neurodevelopment of the survivors is unclear. We aimed to investigate the relationship between neonatal temperature at admission and the risk of cerebral palsy (CP) at one month of age in a low-resource setting. Methods: This retrospective study included all inborn neonates admitted to the Special Care Unit of Tosamaganga Hospital (Tanzania) between 1 January 2019 and 31 December 2020. The neurological examination at one month of age was performed using the Hammersmith method. The relationship between the admission temperature and the risk of CP was investigated using logistic regression models, with temperature modeled as the non-linear term. Results: High/moderate risk of CP was found in 40/119 (33.6%) of the neonates at one month of age. A non-linear relationship between the admission temperature and moderate/high risk of CP at one month of age was found. The lowest probability of moderate/high risk of CP was estimated at admission temperatures of between 35 and 36 °C, with increasing probability when departing from such temperatures. Conclusions: In a low-resource setting, we found a U-shaped relationship between the admission temperature and the risk of CP at one month of life. Expanding the analysis of the follow-up data to 12–24 months of age would be desirable in order to confirm and strengthen such findings.
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Abstract
Purpose of Review Climate change is the biggest public health threat of the twenty-first century but its impact on the perinatal period has only recently received attention. This review summarizes recent literature regarding the impacts of climate change and related environmental disasters on pregnancy health and provides recommendations to inform future adaptation and mitigation efforts. Recent Findings Accumulating evidence suggests that the changing climate affects pregnancy health directly via discrete environmental disasters (i.e., wildfire, extreme heat, hurricane, flood, and drought), and indirectly through changes in the natural and social environment. Although studies vary greatly in design, analytic methods, and assessment strategies, they generally converge to suggest that climate-related disasters are associated with increased risk of gestational complication, pregnancy loss, restricted fetal growth, low birthweight, preterm birth, and selected delivery/newborn complications. Window(s) of exposure with the highest sensitivity are not clear, but both acute and chronic exposures appear important. Furthermore, socioeconomically disadvantaged populations may be more vulnerable. Summary Policy, clinical, and research strategies for adaptation and mitigation should be continued, strengthened, and expanded with cross-disciplinary efforts. Top priorities should include (a) reinforcing and expanding policies to further reduce emission, (b) increasing awareness and education resources for healthcare providers and the public, (c) facilitating access to quality population-based data in low-resource areas, and (d) research efforts to better understand mechanisms of effects, identify susceptible populations and windows of exposure, explore interactive impacts of multiple exposures, and develop novel methods to better quantify pregnancy health impacts.
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Trevisanuto D, Gizzi C, Gagliardi L, Ghirardello S, Di Fabio S, Beke A, Buonocore G, Charitou A, Cucerea M, Degtyareva MV, Filipović-Grčić B, Georgieva Jekova N, Koç E, Saldanha J, Sanchez Luna M, Stoniene D, Varendi H, Vertecchi G, Mosca F, Moretti C. Neonatal Resuscitation Practices in Europe: A Survey of the Union of European Neonatal and Perinatal Societies. Neonatology 2022; 119:184-192. [PMID: 35051924 DOI: 10.1159/000520617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND We aimed to evaluate the policies and practices about neonatal resuscitation in a large sample of European hospitals. METHODS This was a cross-sectional electronic survey. A 91-item questionnaire focusing on the current delivery room practices in neonatal resuscitation domains was individually sent to the directors of 730 European neonatal facilities or (in 5 countries) made available as a Web-based link. A comparison was made between hospitals with ≤2,000 and those with >2,000 births/year and between hospitals in 5 European areas (Eastern Europe, Italy, Mediterranean countries, Turkey, and Western Europe). RESULTS The response rate was 57% and included participants from 33 European countries. In 2018, approximately 1.27 million births occurred at the participating hospitals, with a median of 1,900 births/center (interquartile range: 1,400-3,000). Routine antenatal counseling (p < 0.05), the presence of a resuscitation team at all deliveries (p < 0.01), umbilical cord management (p < 0.01), practices for thermal management (p < 0.05), and heart rate monitoring (p < 0.01) were significantly different between hospitals with ≤2,000 births/year and those with >2,000 births/year. Ethical and educational aspects were similar between hospitals with low and high birth volumes. Significant variance in practice, ethical decision-making, and training programs were found between hospitals in 5 different European areas. CONCLUSIONS Several recommendations about available equipment and clinical practices recommended by the international guidelines are already implemented by centers in Europe, but a large variance still persists. Clinicians and stakeholders should consider this information when allocating resources and planning European perinatal programs.
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Affiliation(s)
- Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Camilla Gizzi
- Department of Pediatrics, Ospedale Sandro Pertini, Rome, Italy.,Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Stefano Ghirardello
- Department of Pediatrics, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Sandra Di Fabio
- Department of Pediatrics, Ospedale San Salvatore, L'Aquila, Italy
| | - Artur Beke
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Giuseppe Buonocore
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Antonia Charitou
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Rea Maternity Hospital, Athens, Greece
| | - Manuela Cucerea
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Neonatology Department, University of Medicine Pharmacy Sciences and Technology "George Emil Palade", Târgu Mures, Romania
| | - Marina V Degtyareva
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Boris Filipović-Grčić
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Nelly Georgieva Jekova
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, University Hospital "Majchin dom", Sofia, Bulgaria
| | - Esin Koç
- Division of Neonatology, Department of Pediatrics, School of Medicine, Gazi University, Ankara, Turkey.,1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Joana Saldanha
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Hospital de Santa Maria, Lisbon, Portugal
| | - Manuel Sanchez Luna
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Neonatology Division, Department of Pediatrics, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Dalia Stoniene
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Heili Varendi
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Tartu University Hospital, Tartu, Estonia
| | - Giulia Vertecchi
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy
| | - Fabio Mosca
- Department of Pediatrics, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Corrado Moretti
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Policlinico Umberto I, Sapienza University, Rome, Italy
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Ercolino O, Baccin E, Alfier F, Villani PE, Trevisanuto D, Cavallin F. Thermal servo-controlled systems in the management of VLBW infants at birth: A systematic review. Front Pediatr 2022; 10:893431. [PMID: 35979410 PMCID: PMC9377414 DOI: 10.3389/fped.2022.893431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Thermal management of the newborn at birth remains an actual challenge. This systematic review aimed to summarize current evidence on the use of thermal servo-controlled systems during stabilization of preterm and VLBW infants immediately at birth. METHODS A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database through December 2021. PRISMA guidelines were followed. Risk of bias was appraised using Cochrane RoB2 and Risk Of Bias In Non-Randomized Studies of Interventions (ROBIN-I) tools, and certainty of evidence using GRADE framework. RESULTS One randomized controlled trial and one observational study were included. Some aspects precluded the feasibility of a meaningful meta-analysis; hence, a qualitative review was conducted. Risk of bias was low in the trial and serious in the observational study. In the trial, the servo-controlled system did not affect normothermia (36.5-37.5°C) but was associated with increased mild hypothermia (from 22.2 to 32.9%). In the observational study, normothermia (36-38°C) increased after the introduction of the servo-controlled system and the extension to larger VLBW infants. CONCLUSION Overall, this review found very limited information on the use of thermal servo-controlled systems during stabilization of preterm and VLBW infants immediately at birth. Further research is needed to investigate the opportunity of including such approach in the neonatal thermal management in delivery room. REGISTRATION PROSPERO (CRD42022309323).
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Affiliation(s)
- Orietta Ercolino
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Erica Baccin
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Fiorenza Alfier
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Paolo Ernesto Villani
- Department of Woman's and Child's Health, Fondazione Poliambulanza, Istituto Ospedaliero, Brescia, Italy
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
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