{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T05:33:26Z","timestamp":1761284006459,"version":"build-2065373602"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite implementation of thermal protection protocols, hypothermia remains common in preterm infants. The relative impact of hypothermia occurring in the delivery room (DR) vs. at NICU admission on neonatal outcomes remains insufficiently reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the association between hypothermia at two key time points\u2014immediately after birth in the DR and upon admission to the NICU\u2014and neonatal mortality and major morbidities in infants born at less than 32 weeks\u2019 gestation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort included inborn preterm infants &amp;lt;32 weeks\u2019 gestation admitted to a tertiary NICU (January 2022\u2013December 2024). Axillary temperatures were obtained after stabilization in the delivery room (DR) and again on NICU admission. Hypothermia was defined as &amp;lt;36.5\u2005\u00b0C; infants were grouped by thermal status at each time point. Outcomes were in-hospital mortality and major morbidities. Associations were evaluated with multivariable logistic regression: morbidity models adjusted for gestational age, and mortality models adjusted for gestational age, major intraventricular hemorrhage (IVH), and sepsis; results are reported as adjusted odds ratios with 95% CIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Hypothermia occurred in 19% of infants in the DR and in 25% at NICU admission. The median temperature change between the DR and NICU was \u22120.1\u2005\u00b0C [IQR: \u22120.2, 0.1], with a significant overall decline (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Mortality was higher in infants who were hypothermic in the DR (26.3% vs. 7.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and at NICU admission (22.4% vs. 7.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). NICU hypothermia was independently associated with bronchopulmonary dysplasia (aOR: 1.89; 95% CI: 1.06\u20133.35), major IVH (aOR: 2.46; 95% CI: 1.05\u20135.75), and surgical necrotizing enterocolitis (aOR: 4.89; 95% CI: 1.48\u201316.17). Delivery-room hypothermia was associated with increased odds of BPD (aOR: 1.88; 95% CI: 1.02\u20133.46) but not with IVH or NEC. Infants hypothermic at both time points had the highest rates of mortality (25.9%) and BPD (59%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hypothermia in the DR and at NICU admission is significantly associated with adverse outcomes, with the highest risk in infants hypothermic at both time points. These observational findings should be interpreted in light of potential selection bias, as smaller and sicker infants are more likely to be hypothermic, and highlight the need to prioritize thermoregulation from birth through admission.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2025.1678128","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T05:28:42Z","timestamp":1761283722000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Delivery-room and NICU admission temperatures in preterm infants &lt;32 weeks at a tertiary centre in Saudi Arabia: associations with mortality and morbidity"],"prefix":"10.3389","volume":"13","author":[{"given":"Kamal","family":"Ali","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohanned","family":"Alrahili","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaimaa","family":"Halabi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Almahdi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seham","family":"Alrsheedi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amenah","family":"Alessa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rana","family":"Almuqati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Talal","family":"Aljarbou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mesaed","family":"Alsenani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulrahman","family":"Mandurah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faisal","family":"Alamer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulrahman","family":"Altuwaym","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulaziz","family":"Homedi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarek","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saif","family":"Alsaif","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/j.siny.2018.03.009","article-title":"Maintaining normothermia: why and how?","volume":"23","author":"Trevisanuto","year":"2018","journal-title":"Semin Fetal Neonatal Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e150277","DOI":"10.1001\/jamapediatrics.2015.0277","article-title":"Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks\u2019 gestation","volume":"169","author":"Lyu","year":"2015","journal-title":"JAMA Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.ijpam.2022.12.001","article-title":"Admission temperature and neonatal outcomes\u2014single-centre experience in Saudi Arabia","volume":"9","author":"Fneish","year":"2022","journal-title":"Int J Pediatr Adolesc Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/1741-7015-11-24","article-title":"The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival","volume":"11","author":"Lunze","year":"2013","journal-title":"BMC Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e643","DOI":"10.1542\/peds.2006-0943","article-title":"Admission temperature of low birth weight infants: predictors and associated morbidities","volume":"119","author":"Laptook","year":"2007","journal-title":"Pediatrics"},{"key":"B6","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s40748-021-00134-6","article-title":"Outcomes of neonatal hypothermia among very low birth weight infants: a meta-analysis","volume":"7","author":"Mohamed","year":"2021","journal-title":"Matern Health Neonatol Perinatol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1891\/11-T-756","article-title":"The NRP 8th edition: innovation in education","volume":"40","author":"Zaichkin","year":"2021","journal-title":"Neonatal Netw"},{"key":"B8","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1164\/rccm.201812-2348OC","article-title":"The diagnosis of bronchopulmonary dysplasia in very preterm infants. An evidence-based approach","volume":"200","author":"Jensen","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/S0022-3476(78)80282-0","article-title":"Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500\u2005gm","volume":"92","author":"Papile","year":"1978","journal-title":"J Pediatr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e51","DOI":"10.1016\/j.ophtha.2021.05.031","article-title":"International classification of retinopathy of prematurity, third edition","volume":"128","author":"Chiang","year":"2021","journal-title":"Ophthalmology"},{"key":"B11","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1056\/NEJM197802022980519","article-title":"Neonatal necrotizing enterocolitis","volume":"298","author":"Bell","year":"1978","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e2024069668","DOI":"10.1542\/peds.2024-069668","article-title":"Hypothermia and adverse outcomes in very preterm infants: a systematic review","volume":"155","author":"Hogeveen","year":"2025","journal-title":"Pediatrics"},{"key":"B13","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1186\/s12887-020-02024-w","article-title":"Prevalence of neonatal hypothermia and its associated factors in east Africa: a systematic review and meta-analysis","volume":"20","author":"Beletew","year":"2020","journal-title":"BMC Pediatr"},{"key":"B14","doi-asserted-by":"publisher","first-page":"893431","DOI":"10.3389\/fped.2022.893431","article-title":"Thermal servo-controlled systems in the management of VLBW infants at birth: a systematic review","volume":"10","author":"Ercolino","year":"2022","journal-title":"Front Pediatr"},{"key":"B15","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1093\/tropej\/fmz086","article-title":"Association of neonatal hypothermia with morbidity and mortality in a tertiary hospital in Malawi","volume":"66","author":"Phoya","year":"2020","journal-title":"J Trop Pediatr"},{"key":"B16","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1093\/tropej\/39.1.4","article-title":"A survey of technology and temperature control on a neonatal unit in Kathmandu, Nepal","volume":"39","author":"Johanson","year":"1993","journal-title":"J Trop Pediatr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e003233","DOI":"10.1136\/bmjpo-2024-003233","article-title":"Prevalence and associated factors of admission hypothermia among neonates admitted to the premature baby unit of a secondary care hospital in Sri Lanka: a cross-sectional analytical study","volume":"9","author":"Kasturiarachchi","year":"2025","journal-title":"BMJ Paediatr Open"},{"key":"B18","doi-asserted-by":"publisher","first-page":"CD004210","DOI":"10.1002\/14651858.CD004210.pub5","article-title":"Interventions to prevent hypothermia at birth in preterm and\/or low birth weight infants","volume":"2","author":"McCall","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"B19","doi-asserted-by":"publisher","first-page":"CD001074","DOI":"10.1002\/14651858.CD001074","article-title":"Servo-control for maintaining abdominal skin temperature at 36C in low birth weight infants","volume":"2002","author":"Sinclair","year":"2002","journal-title":"Cochrane Database Syst Rev"},{"key":"B20","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1136\/archdischild-2020-320567","article-title":"Thermal management with and without servo-controlled system in preterm infants immediately after birth: a multicentre, randomised controlled study","volume":"106","author":"Cavallin","year":"2021","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B21","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.jpeds.2016.04.016","article-title":"Admission hypothermia in very preterm infants and neonatal mortality and morbidity","volume":"175","author":"Wilson","year":"2016","journal-title":"J Pediatr"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2298","DOI":"10.1055\/s-0044-1786873","article-title":"Association between neonatal outcomes and admission hypothermia among very preterm infants in Chinese neonatal intensive care units: a multicenter cohort study","volume":"41","author":"Hong","year":"2024","journal-title":"Am J Perinatol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1186\/s12887-020-02221-7","article-title":"Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study","volume":"20","author":"Yu","year":"2020","journal-title":"BMC Pediatr"},{"key":"B24","doi-asserted-by":"publisher","first-page":"11912","DOI":"10.1038\/s41598-022-15979-w","article-title":"Admission temperature of very low birth weight infants and outcomes at three years old","volume":"12","author":"Kato","year":"2022","journal-title":"Sci Rep"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1055\/a-2575-2994","article-title":"Impact of the transition of neonatal body temperature from resuscitation to admission on prematurity complications: a retrospective observational study","author":"Limpivilas","year":"2025","journal-title":"Am J Perinatol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"386","DOI":"10.3345\/kjp.2019.00206","article-title":"Clinical impact of admission hypothermia in very low birth weight infants: results from Korean neonatal network","volume":"62","author":"Lee","year":"2019","journal-title":"Korean J Pediatr"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1678128\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T05:28:42Z","timestamp":1761283722000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1678128\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,24]]},"references-count":26,"alternative-id":["10.3389\/fped.2025.1678128"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1678128","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,24]]},"article-number":"1678128"}}