Rapid vs. Slow Rewarming for Management of Moderate to Severe Hypothermia in Low-Birth-Weight Pre-term Neonates-An Open Label Randomized Controlled Trial.

Abstract

BACKGROUND:

Evidence is lacking regarding the optimal method of rewarming hypothermic low-birth-weight (LBW) pre-term neonates. We aim to evaluate the effect of rapid vs. slow rewarming in the management of moderate to severe hypothermia in LBW pre-term neonates.

METHODS:

In this open label, randomized controlled trial, 100 LBW (<2.5 kg), pre-term (<37 weeks) neonates with moderate to severe hypothermia (<36°C) was randomized to two groups of 50 each and received either rapid (at >0.5°C/h) or slow (at ≤0.5°C/h) rewarming rate till normothermia. The primary outcome was stabilization score [TOPS (temperature, oxygenation, perfusion and saturation) and MSNS (modified sick neonatal score)] at baseline, 6 and 24 h and mortality until discharge. Other neonatal morbidities were assessed as secondary outcomes.

RESULTS:

Mean TOPS score and MSNS score at baseline, 6 and 24 h of admission as well as change in score from baseline were similar between the two groups. The median rewarming rate [interquartile range (IQR)] was higher in rapid rewarming group than in the slow rewarming group [5.05°C/h (3.54-7.71) vs. 0.71°C/h (0.60-0.90); p < 0.001]. The median rewarming time taken in rapid rewarming group was lesser compared with that in the slow rewarming group [0.31 h (IQR 0.13-0.75) vs. 2.05 h (IQR 1.11-3.03); p < 0.001]. Mortality in rapid rewarming and slow rewarming group was similar [7/50 vs. 5/50; OR 1.46 (0.43-4.97), p = 0.538].

CONCLUSION:

Rapid rewarming was as effective and safe as slow rewarming in the management of moderate to severe hypothermia in LBW pre-term neonates with similar short-term neonatal outcomes.

CTRI NUMBER:

CTRI/2018/01/011187.

• Authors: Prerana Jain, Jagjit Singh Dalal, Geeta Gathwala
• Journal: Journal of tropical pediatrics (J Trop Pediatr) Vol. 67 Issue 1 (01 29 2021) ISSN: 1465-3664 [Electronic] England
• PMID: 33381805 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © The Author(s) [2020]. Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected].

Topics

• Humans
• Hypothermia (therapy)
• Hypothermia, Induced
• Infant, Low Birth Weight
• Infant, Newborn
• Rewarming