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Servo-control for maintaining abdominal skin temperature at 36C in low birth weight infants

  • Review
  • Intervention

Authors

  • John C. Sinclair

    Corresponding author
    1. McMaster University Medical Centre, Department of Pediatrics and Clinical Epidemiology, Hamilton, Ontario, Canada
    • John C. Sinclair, Department of Pediatrics and Clinical Epidemiology, McMaster University Medical Centre, 1200 Main Street West, Room 3N11F, Hamilton, Ontario, L8N 3Z5, Canada. sinclair@mcmaster.ca.

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Abstract

Background

Randomized trials have shown that the neonatal mortality rate of low birth-weight babies can be reduced by keeping them warm. For low birth-weight babies nursed in incubators, warm conditions may be achieved either by heating the air to a desired temperature, or by servo-controlling the baby's body temperature at a desired set-point.

Objectives

In low birth weight infants, to determine the effect on death and other important clinical outcomes of targeting body temperature rather than air temperature as the end-point of control of incubator heating.

Search methods

Standard search strategy of the Cochrane Neonatal Review Group. Searches were made of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2004) and MEDLINE, 1966 to April 2008.

Selection criteria

Randomized or quasi-randomized trials which test the effects of having the heat output of the incubator servo-controlled from body temperature compared with setting a constant incubator air temperature.

Data collection and analysis

Trial methodologic quality was systematically assessed. Outcome measures included death, timing of death, cause of death, and other clinical outcomes. Categorical outcomes were analyzed using relative risk and risk difference. Meta-analysis assumed a fixed effect model.

Main results

Two eligible trials were found. In total, they included 283 babies and 112 deaths. Compared to setting a constant incubator air temperature of 31.8C, servo-control of abdominal skin temperature at 36C reduces the neonatal death rate among low birth weight infants: relative risk 0.72 (95% CI 0.54, 0.97); risk difference -12.7% (95% CI -1.6, -23.9). This effect is even greater among VLBW infants.

Authors' conclusions

During at least the first week after birth, low birth weight babies should be provided with a carefully regulated thermal environment that is near the thermoneutral point. For LBW babies in incubators, this can be achieved by adjusting incubator temperature to maintain an anterior abdominal skin temperature of at least 36C, using either servo-control or frequent manual adjustment of incubator air temperature.

摘要

背景

以電腦伺服器即時控制系統維持低出生體重新生兒之腹部體表溫度維持於36℃

隨機試驗顯示使低出生體重新生兒維持體溫可減少死亡率。對於安置在保溫箱中的低體重新生兒,維持溫度的方法可藉由加熱空氣至需要的溫度,或是藉由電腦伺服器即時控制系統將新生兒體溫控制於設定溫度。

目標

探討保溫箱控溫方式(調節體溫達設定溫度或調節空氣溫度達設定溫度)對低出生體重新生兒之死亡率及其它重大預後之影響。

搜尋策略

根據Cochrane Neonatal Review Group的標準搜尋策略,搜尋包括Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2004) and MEDLINE, 1966 to June 2004.等資料庫

選擇標準

以隨機或準隨機試驗評估兩種控溫方式(由伺服器根據體溫調節熱能輸出或將保溫箱設定於一定溫度)之比較

資料收集與分析

各試驗的研究方法均經過系統性地評估。試驗結果包括是否造成死亡、死亡的時間及原因、以及其它臨床預後。相關的結果則使用relative risk及risk difference作分析。Metaanallysis則設定為固定的effect model。

主要結論

兩個相關的試驗中共包含了283位新生兒及112個死亡案例。相較之下,利用電腦伺服器即時控制系統控制腹部體表溫度於36℃比起固定保溫箱溫度設定於31.8℃能減少低體重新生兒之死亡率[relative risk 0.72 (95% CI 0.54, 0.97); risk difference −12.7% (95% CI −1.6, −23.9).],尤其是在極低出生體重新生兒身上更為顯著。

作者結論

低出生體重新生兒在出生後至少一週內都應該被照護於嚴格控溫於接近熱平衡的環境內。對於在保溫箱中的低出生體重新生兒來說,嚴格控溫可藉由電腦伺服器即時控制系統控制或頻繁的手動調整保溫箱溫度,以維持前腹體表溫度大於36℃。

翻譯人

本摘要由高雄醫學大學附設醫院陳利旻翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

利用電腦伺服器即時控制系統控制腹部體表溫度於36℃比起固定保溫箱溫度設定於31.8℃能減少低體重新生兒之死亡率.

Plain language summary

Servo-control for maintaining abdominal skin temperature at 36C in low birth weight infants

Low birth weight babies have a higher chance or survival if they are kept warm. The right conditions can be made by placing the baby in an incubator. The air can be heated to a desired temperature, or radiant heat lamps inside the incubator can adjust to the baby’s body temperature (servo-control). The review of trials found that keeping a baby’s skin temperature at 36C degrees by servo-control reduces the newborn death rate in low birth weight babies rather than setting a constant incubator temperature of 31.8C. More research is needed.

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