ปัจจัยที่มีความสัมพันธ์ต่อภาวะอุณหภูมิกายต่าในทารกเกิดก่อนกาหนด น้าหนักแรกเกิดน้อยกว่า 1,500 กรัม ขณะแรกรับ ในหอผู้ป่วยหนักทารกแรกเกิด โรงพยาบาลมหาราชนครเชียงใหม่

Lawan Thawitha; Navapun Papana; Nonglak Inta

Authors

Lawan Thawitha Neonatal intensive care unit 1, Maharaj Nakorn Chiang Mai Hospital
Navapun Papana Neonatal intensive care unit 2, Maharaj Nakorn Chiang Mai Hospital
Nonglak Inta Nursing research unit, Maharaj Nakorn Chiang Mai Hospital

Keywords:

Hypothermia, premature infants, infants with a birth weight less than 1,500 grams, factors associated with hypothermia

Abstract

This retrospective descriptive study aimed to examine factors associated with hypothermia in preterm infants with birth weight less than 1,500 grams upon the first admission to the neonatal intensive care unit (NICU), Maharaj Nakorn Chiang Mai Hospital. The purposive sampling were 237 preterm infants with birth weight less than 1,500 grams who were born at Maharaj Nakorn Chiang Mai Hospital. Data were collected retrospectively from the hospital medical registration department from January 1, 2019 to December 31, 2023. Research instruments consisted of: (1) a data collection form recording four factors associated with hypothermia in preterm infants namely: infant factors, environmental factors, equipment factors, and personnel factors, and (2) a body temperature record body from upon admission. Data were analyzed using descriptive statistics and Chi-square test.

The findings showed that 147 preterm infants (62.03%) with birth weight less than 1,500 grams demonstrated hypothermia upon admission. Eighty of them (54.42%) had mild hypothermia, 67 infants (45.58%) exhibited moderate to severe hypothermia (<36.0°C). It was found that the mode of delivery, birth weight, Apgar scores, and place of birth had statistically significant associated with hypothermia upon admission with p<.001, p<.01, and p<.05, respectively. However, the use of plastic wrap or plastic bag, the equipment used for transportation, and personnel-related factors were not statistically significant associated with hypothermia upon admission.

The results of this study serve as a preliminary information for healthcare professionals to understand factors associated with hypothermia upon admission, leading to the development of Clinical Practice Guidelines for preterm infants in order to reduce in the incidence of hypothermia, and increase the survival rate effectively.

References

World Health Organization. Thermal protection of the newborn: a practical guide [Internet]. Geneva: WHO; 1997 [cited 2025 Feb,20]. Available from: https://policycommons.net/artifacts/568747/

thermal-protection-of-the-newborn/1547115/

Demtse AG, Pfister RE, Nigussie AK, McClure EM, Ferede YG, Tazu Bonger Z, et al. Hypothermia in preterm newborns: impact on survival. Glob Pediatr Health [Internet]. 2020 [cited 2025 Mar,11];7:2333794X20957655. Available from: https://doi.org/10.1177/2333794X20957655

Vygon C. Hypothermia in newborns, how to prevent it? [Internet]. 2024 [cited 2025 Mar, 11]. Available from: https://campusvygon.com/global/hypothermia-in-newborns-how-to-prevent-it/

Nimbalkar S, Swamy AR. Neonatal hypothermia: standard treatment guideline 2022 [Internet]. 2022 [cited 2025 Feb,25]. Available from: https://www.scribd.com/document/614624752/Ch-067-

Neonatal-Hypothermia

Yitayew YA, Aitaye EB, Lechissa HW, Gebeyehu LO. Neonatal hypothermia and associated factors among newborns admitted in the neonatal intensive care unit of Dessie Referral Hospital, Amhara Region, Northeast Ethiopia. Int J Pediatr [Internet]. 2020 [cited 2025 Feb, 25];2020:3013427. Available from: https://doi.org/10.1155/2020/3013427

Soares T, Pedroza GA, Breigeiron MK, Cunha ML. Prevalence of hypothermia in the first hour of life of premature infants weighing ≤1500 g. Rev Gaucha Enferm. 2019;41:e20190094.

Yu YH, Wang L, Huang L, Wang LL, Huang XY, Fan XF, et al. Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study. BMC Pediatr 2020;20(1):321. doi:10.1186/s12887-020-02221-7

ศศิพรรณ จองวัฒนากิจ. สาเหตุที่ทำให้เกิดอุณหภูมิกายต่ำในทารกแรกเกิด หอผู้ป่วยหนักทารกแรกเกิด และเด็ก โรงพยาบาลลำพูน. ใน: เอกสารประกอบการบรรยาย การประชุมวิชาการชมรมเครือข่ายวิจัยโรงพยาบาล; 23–26 ส.ค. 2559; เชียงใหม่: โรงแรมสวนบัวรีสอร์ท [Internet]. [cited 2025 Feb,25]. Available from: https://www.zroldev.com/lpnhresearch/index.php/en/2559/42-2017-02-20-07-22-01

Prachukthum S, Techasatid W, Sahussarungsri S, Chompikul R, Seephan S, Khampho N, et al. Prevention of admission hypothermia in low-birth-weight infants through PDSA cycle of quality improvement initiative. The Journal of Medical Association of Thailand 2023;106(2): 160-4. (in Thai).

Muengpan T, Kaphan K, Buakamsound A, Boonma N, Boonla O, Woragidpoonpol P. Incidence and associated factors with neonatal hypothermia in nursery unit. Songklanagarind Journal of Nursing 2020;40(4):111-21. (in Thai)

ประชา นันท์นฤมิต. การวัดและการควบคุมอุณหภูมิกายในทารกแรกเกิด. ใน: ประชา นันท์นฤมิต, บรรณาธิการ. การประยุกต์ความรู้ทางสรีรวิทยาในการดูแลทารกแรกเกิด. กรุงเทพฯ: โฮลิสติกพับลิชชิ่ง; 2558.

Chang HY, Sung YH, Wang SM, Lung HL, Chang JH, Hsu CH, et al. Short- and long-term outcomes in very low birth weight infants with admission hypothermia. PLoS One [Internet]. 2015 [cited 2025 Jul,4];10(7):e0131976. Available from: https://doi.org/10.1371/journal.pone.0131976

Chiu WT, Lu YH, Chen YT, Tan YL, Lin YC, Chen YL, et al. Reducing intraventricular hemorrhage following the implementation of a prevention bundle for neonatal hypothermia. PLoS One [Internet]. 2022 Sep 2 [cited 2025 Jul,4];17(9):e0273946. Available from: https://doi.org/10.1371/journal.pone.0273946

Carvalho JO, Toledo LV, Braga LM, Krempser P, Pacheco ZM, Dutra HS. Hypothermia among premature newborns on admission to a neonatal intensive care unit. Rev Gaucha Enferm [Internet]. 2023 [cited 2025 Jul,4];44:e20220042. Available from: https://doi.org/10.1590/1983-1447.2023.20220042.en

Shi Q, Zhang J, Fan C, Zhang A, Zhu Z, Tian Y. Factors influencing hypothermia in very low/extremely low birth weight infants: a meta-analysis. PeerJ 2023;11:e14907. doi:10.7717/peerj.14907

Ukke GG, Diriba K. Prevalence and factors associated with neonatal hypothermia on admission to neonatal intensive care units in Southwest Ethiopia: a cross-sectional study. PLoS One 2019 14(6):e0218020. doi:10.1371/journal.pone.0218020

Daniel E, Seif SA, Millanzi WC. Predictors of newborn hypothermia in the first 6 hours after delivery among newborns in Kilimanjaro region—Tanzania: an analytical cross-sectional study. Medicine (Baltimore) 2025;104(17):e42018. doi:10.1097/MD.0000000000042018

Johannsen JK, Vochem M, Neuberger P. Does a higher ambient temperature in the delivery room prevent hypothermia in preterm infants <1500 g?. Z Geburtshilfe Neonatol 2017;221(5):235-40. doi:10.1055/s-0043-118809

Ramaswamy VV, Dawson JA, de Almeida MF, Trevisanuto D, Nakwa FL, Kamlin CO, et al. Maintaining normothermia immediately after birth in preterm infants <34 weeks’ gestation: a systematic review and meta-analysis. Resuscitation 2023;191:109934. doi:10.1016/j.resuscitation.2023.109934

Sanni UA, Usman F, Ogunkunle TO, Adamu AS, Lamidi AI, Lawal TO, et al. Hypothermia in preterm infants admitted to low-resource neonatal units in northern Nigeria: an observational study of occurrence and risk factors. BMC Pediatr 2024;24(1):471. doi:10.1186/s12887-024-04960-3

Wongprasert P. Incidence and severity of hypothermia in unplanned out-of-hospital birth. Thai journal of Emergency Medicine 2020;2(2):51-63. (in Thai)

Gopalakrishnan S, Karmani S, Ramar P, Pandey A, Sodhi K. Conductive thermal mattress versus routine care to reduce neonatal hypothermia during transport among low-birthweight neonates: An experimental study with historical controls. Medical Journal Armed Forces India [Internet]. 2022 [cited 2025 Sep,21];78:S49-54. Available from: https://doi.org/10.1016/j.mjafi.2020.10.022

Balakrishnan M, Falk-Smith N, Detman LA, Miladinovic B, Sappenfield WM, Curran JS, et al. Promoting teamwork may improve infant care processes during delivery room management: Florida perinatal quality collaborative’s approach. J Perinatol [Internet]. 2017 [cited 2025 Jul,4];37(7):886-92. Available from: https://doi.org/10.1038/jp.2017.27

Abdellatif M, Al Ghafri FM, Al Khabori M, Khan AA, Al Riyami N, Hassan M. Hypothermia in preterm neonates in Oman: a retrospective study. Oman Med J [Internet]. 2024 [cited 2025 Nov 1];39(4):e652. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11663241/

Maharaj Nakorn Chiang Mai Hospital. Raw data: Neonatal Intensive Care Unit. Chiang Mai: Maharaj Nakorn Chiang Mai Hospital; 2023. [unpublished data].

Roaché DJ. Intercoder reliability techniques: percent agreement. In: The SAGE encyclopedia of communication research methods. Thousand Oaks (CA): SAGE Publications; 2017:252. doi:10.4135/9781483381411.n260

Hogeveen M, Hooft L, Onland W. Hypothermia and adverse outcomes in very preterm infants: a systematic review. Pediatrics 2025;155(5):e2024069668. doi:10.1542/peds.2024-069668

Wilson E, Maier RF, Norman M, Misselwitz B, Howell EA, Zeitlin J, et al. Admission hypothermia in very preterm infants and neonatal mortality and morbidity. J Pediatr 2016 Aug 1;175:61-7. doi:10.1016/j.jpeds.2016.04.016

ภารดี ชาวนรินทร์, ทิพพาพรรณ เดียวประเสริฐ, ปุณณิภัสส์ อริยะปรานต์, สมฤดี กีรวนิชเสถียร. การป้องกันภาวะอุณหภูมิกายต่ำในทารกแรกเกิด. พยาบาลสาร 2564;70(4):52-9.

Wainaina J, Ogero M, Mumelo L, Wairoto K, Mbevi G, Tuti T, et al. Hypothermia amongst neonatal admissions in Kenya: a retrospective cohort study assessing prevalence, trends, associated factors, and its relationship with all-cause neonatal mortality. Front Pediatr [Internet]. 2024 [cited,4];12:1272104. Available from: https://doi.org/10.3389/fped.2024.1272104

Elbaum C, Beam KS, Dammann O, Dammann CE. Antecedents and outcomes of hypothermia at admission to the neonatal intensive care unit. J Matern Fetal Neonatal Med [Internet]. 2021 [cited 2025 Jul,4];34(1):66-71. Available from: https://doi.org/10.1080/14767058.2019.1597043