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Use of Heated Humidified Gases for Early Stabilization of Preterm Infants: A Meta-Analysis

Background: Large observational studies in preterm infants have shown an increase in mortality and morbidity when admission temperature is below 36.5°C. Recent randomized controlled studies have shown a reduction in admission hypothermia and an increase in the number of infants admitted with normal...

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Autores principales: Meyer, Michael P., Owen, Louise S., te Pas, Arjan B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209662/
https://www.ncbi.nlm.nih.gov/pubmed/30410876
http://dx.doi.org/10.3389/fped.2018.00319
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author Meyer, Michael P.
Owen, Louise S.
te Pas, Arjan B.
author_facet Meyer, Michael P.
Owen, Louise S.
te Pas, Arjan B.
author_sort Meyer, Michael P.
collection PubMed
description Background: Large observational studies in preterm infants have shown an increase in mortality and morbidity when admission temperature is below 36.5°C. Recent randomized controlled studies have shown a reduction in admission hypothermia and an increase in the number of infants admitted with normal temperature (36.5–37.5°C) when heated humidified gases were used for initial stabilization of preterm infants. Objective: The goal of this study was to perform a meta-analysis of published randomized trials using heated humidified gas compared to cold dry gas in preterm infants immediately after birth and during transport to the neonatal unit. Specific research aims were to determine the magnitude of the reduction in hypothermia and to examine neonatal outcomes including mortality. Methods: A literature search was conducted in accordance with the standard methods of the Cochrane Neonatal Work Group. Randomized trials were identified and data entered into RevMan5. A fixed effects statistical model was used. Risk of bias was assessed for included studies and the GRADE approach used to determine quality of evidence. The primary outcome was admission hypothermia (< 36.5°C). Secondary outcomes included admission temperature in the normothermic range (36.5–37.5°C) and neonatal outcomes including mortality. Results: Two studies met inclusion criteria and a total of 476 preterm infants were enrolled, all of whom were < 32 weeks gestation. Studies were not blinded but the overall risk of bias was low. Admission hypothermia was reduced by 36% (CI 17–50%), while admission normothermia was significantly increased. GRADE quality of evidence was high for these outcomes. The number of infants with more severe hypothermia (< 35.5°C) was significantly reduced (RR 0.32 CI 0.14-0.73). In addition, preterm infants < 28 weeks had significantly less admission hypothermia (RR 0.61 CI 0.42, 0.90) Mortality and measures of respiratory outcome were not significantly different (studies were not powered for these outcomes), though there was a trend to improvement in all respiratory measures assessed. There were no significant adverse events and no increase in admission hyperthermia (>37.5°C). Conclusions: Heating and humidification of inspired gases immediately after birth and during transport to the neonatal unit improves admission temperature in preterm infants. Consideration should be given to incorporating this technique into other strategies (e.g., use of plastic wrap) designed to keep preterm infants warm on admission to the neonatal unit.
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spelling pubmed-62096622018-11-08 Use of Heated Humidified Gases for Early Stabilization of Preterm Infants: A Meta-Analysis Meyer, Michael P. Owen, Louise S. te Pas, Arjan B. Front Pediatr Pediatrics Background: Large observational studies in preterm infants have shown an increase in mortality and morbidity when admission temperature is below 36.5°C. Recent randomized controlled studies have shown a reduction in admission hypothermia and an increase in the number of infants admitted with normal temperature (36.5–37.5°C) when heated humidified gases were used for initial stabilization of preterm infants. Objective: The goal of this study was to perform a meta-analysis of published randomized trials using heated humidified gas compared to cold dry gas in preterm infants immediately after birth and during transport to the neonatal unit. Specific research aims were to determine the magnitude of the reduction in hypothermia and to examine neonatal outcomes including mortality. Methods: A literature search was conducted in accordance with the standard methods of the Cochrane Neonatal Work Group. Randomized trials were identified and data entered into RevMan5. A fixed effects statistical model was used. Risk of bias was assessed for included studies and the GRADE approach used to determine quality of evidence. The primary outcome was admission hypothermia (< 36.5°C). Secondary outcomes included admission temperature in the normothermic range (36.5–37.5°C) and neonatal outcomes including mortality. Results: Two studies met inclusion criteria and a total of 476 preterm infants were enrolled, all of whom were < 32 weeks gestation. Studies were not blinded but the overall risk of bias was low. Admission hypothermia was reduced by 36% (CI 17–50%), while admission normothermia was significantly increased. GRADE quality of evidence was high for these outcomes. The number of infants with more severe hypothermia (< 35.5°C) was significantly reduced (RR 0.32 CI 0.14-0.73). In addition, preterm infants < 28 weeks had significantly less admission hypothermia (RR 0.61 CI 0.42, 0.90) Mortality and measures of respiratory outcome were not significantly different (studies were not powered for these outcomes), though there was a trend to improvement in all respiratory measures assessed. There were no significant adverse events and no increase in admission hyperthermia (>37.5°C). Conclusions: Heating and humidification of inspired gases immediately after birth and during transport to the neonatal unit improves admission temperature in preterm infants. Consideration should be given to incorporating this technique into other strategies (e.g., use of plastic wrap) designed to keep preterm infants warm on admission to the neonatal unit. Frontiers Media S.A. 2018-10-25 /pmc/articles/PMC6209662/ /pubmed/30410876 http://dx.doi.org/10.3389/fped.2018.00319 Text en Copyright © 2018 Meyer, Owen and te Pas. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Meyer, Michael P.
Owen, Louise S.
te Pas, Arjan B.
Use of Heated Humidified Gases for Early Stabilization of Preterm Infants: A Meta-Analysis
title Use of Heated Humidified Gases for Early Stabilization of Preterm Infants: A Meta-Analysis
title_full Use of Heated Humidified Gases for Early Stabilization of Preterm Infants: A Meta-Analysis
title_fullStr Use of Heated Humidified Gases for Early Stabilization of Preterm Infants: A Meta-Analysis
title_full_unstemmed Use of Heated Humidified Gases for Early Stabilization of Preterm Infants: A Meta-Analysis
title_short Use of Heated Humidified Gases for Early Stabilization of Preterm Infants: A Meta-Analysis
title_sort use of heated humidified gases for early stabilization of preterm infants: a meta-analysis
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209662/
https://www.ncbi.nlm.nih.gov/pubmed/30410876
http://dx.doi.org/10.3389/fped.2018.00319
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