系统评价入院体温分布情况及其对早产儿结局的影响

Systematic review of preterm infants′ body temperature at admission and its effects on the clinical outcome

目的 系统评价早产儿入院体温分布情况及其对早产儿结局的影响。 方法 检索PubMed、Embase、Cochrane图书馆、中国期刊全文数据库、万方数据库、维普中文科技期刊数据库,检索文献时间均从建库至2018年6月。纳入早产儿入院体温分布情况及入院低体温对早产儿结局影响的文献,并对纳入文献质量进行评价。应用STATA 12.0对不同入院体温分布情况及入院低体温对早产儿结局的影响进行统计分析。计数资料采用两个率的比值比(odds ratio,OR)及其95%可信区间(confidence interval,CI)表示。 结果 共纳入16篇文献,包括15项研究,47 113例早产儿。不同入院体温<35℃、<36℃、<36.5℃、36.5-37.4℃、≥37.5℃的发生率及95%CI分别为10.3%(7.6%-13.1%)、45.3%(35.0%-55.5%)、63.5%(51.8%-75.2%)、35.1%(25.6%-44.7%)、4.2%(2.6%-5.7%)。与入院体温36.5-37.4℃相比,入院体温<35℃、35-35.9℃、36-36.4℃增加早产儿病死率,OR(95%CI)分别为6.10(4.88-7.62)、1.96(1.45-2.66)、1.31(1.16-1.48),P均<0.01;入院体温≥37.5℃对早产儿病死率没有影响,OR(95%CI)为0.98(0.73-1.32),P=0.91;入院体温<36℃增加重度早产儿视网膜病(retinopathy of prematurity,ROP)、坏死性小肠结肠炎(necrotizing enterocolitis,NEC)、败血症、脑室周围白质软化症(periventricular leukomalacia,PVL)+脑室内出血(intraventricular hemorrhage,IVH)发生率,OR(95%CI)分别为1.70(1.45-2.00)、1.27(1.08-1.49)、1.44(1.28-1.61)、1.26(1.07-1.48),P均<0.01;入院体温<36℃不增加支气管肺发育不良(bronchopulmonary dysplasia,BPD)发生率,OR(95%CI)为1.03(0.76-1.38),P=0.87;入院体温36-36.4℃不增加重度ROP、NEC、BPD、败血症、PVL+IVH发生率,OR(95%CI)分别为1.19(0.92-1.54)、1.01(0.86-1.18)、0.91(0.68-1.22)、1.02(0.91-1.14)、0.98(0.85-1.14),P均>0.05。 结论 入院体温<35℃、35-35.9℃、36-36.4℃与入院体温36.5-37.4℃相比,早产儿病死率增加,体温越低,早产儿死亡风险越高。早产儿入院体温<36℃与入院体温36.5-37.4℃相比,重度ROP、NEC、败血症、PVL+IVH发生率增加。

Objective To study the distribution of preterm infants′ body temperature at admission and its effects on the clinical outcome. Method The distribution of preterm infants′ body temperature at admission and its effects on their clinical outcome were searched in the Cochrane library, PubMed, Embase, Wanfang, CNKI, VIP from the initial establishment of these databases to June 2018. The quality of the included studies were assessed. STATA 12.0 software was used for statistical analysis. The odds ratio (OR) and 95% confidence interval(CI) were used for continuous variables. Result A total of 16 studies (including 15 clinical trials) with 47 113 cases were included. The incidences of different admission temperatures were as follows:<35℃: 10.3% (7.6%-13.1%), <36℃: 45.3% (35.0%-55.5%), <36.5℃: 63.5% (51.8%-75.2%), 36.5-37.4℃: 35.1% (25.6%-44.7%), ≥37.5℃: 4.2% (2.6%-5.7%). Compared with normothermia (36.5-37.4℃), hypothermia (<35℃, 35-35.9℃, 36-36.4℃) increased the mortality, with the OR and 95%CI as follows: 6.10(4.88-7.62), 1.96(1.45-2.66), 1.31(1.16-1.48);hyperthermia (≥37.5℃) was not associated with higher mortality (OR=0.98, 95%CI 0.73-1.32, P=0.91). Compared with normothermia (36.5-37.4℃), hypothermia (<36℃) increased the risks of severe retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), sepsis, periventricular leukomalacia (PVL) and intraventricular hemorrhage (IVH), with the OR and 95%CI as follows: ROP: 1.70(1.45-2.00), NEC: 1.27(1.08-1.49), sepsis: 1.44(1.28-1.61), PVL/IVH: 1.26(1.07-1.48), but not the risk of bronchopulmonary dysplasia (BPD, OR=1.03, 95%CI 0.76-1.38, P=0.87). Compared with normothermia (36.5-37.4℃), the temperature between 36-36.4℃ did not increase the risk of severe ROP, NEC, BPD, sepsis, PVL/IVH, with the OR and 95%CI as follows: 1.19(0.92-1.54), 1.01(0.86-1.18), 0.91(0.68-1.22), 1.02(0.91-1.14), 0.98(0.85-1.14). Conclusion Admission temperature of <35℃, 35-35.9℃,and 36-36.4℃ increased the mortality risk compared with 36.5-37.4℃, and the lower admission temperature, the higher mortality risk. Admission hypothermia (<36℃) increased the risk of severe ROP, NEC, sepsis, PVL/IVH compared with normothermia (36.5-37.4℃).