Investigation of the Mechanisms of the Tendency to Hypothermia in Newborns and Premature Neonates

Investigation of the Mechanisms of the Tendency to Hypothermia in Newborns and Premature Infants During Surgical Interventions and in the Intensive Care Unit (Non-Interventional, Single-Center, Prospective Clinical Research)

Newborns have thermoregulatory mechanisms that differ from those of adults. Instead of producing heat through shivering, newborns primarily rely on non-shivering thermogenesis by the brown adipose tissue. The development of this thermogenic tissue starts around the 26th gestational week and continues until shortly before birth, after which no further growth occurs. As a result, premature infants, who have less developed brown fat, are more prone to reduced heat production and are at higher risk for hypothermia. There are few human studies examining the thermoregulatory differences and mechanisms between full-term and premature neonates, and the findings remain inconclusive.

In this study, the investigators aim to conduct a prospective, observational research. Researchers will compare body temperature, brown adipose tissue activity, and specific plasma markers between full-term and premature neonates in insensive care units and during elective surgeries.

Study Overview

• Status: Recruiting
• Conditions: Brown Adipose Tissue; Neonatal Hypothermia; Blood Markers; Thermogenesis; Neonate; Preterm and Term Infants

Detailed Description

Test Methods:

Both substudies involve the use of a FLIR C3 mobile thermal camera to create thermograms. Thermal images of the full-term and preterm infants are taken from a distance of 20 cm while the participants lie in a supine position. The area examined spans from the upper edge of the diaper to the top of the head.

Substudy 1:

1. a) In case of neonates in the intensive care unit or waiting for short procedures (e.g., ophthalmic surgery), thermal images are taken before transport to the operating room and after surgery, before transferring back to the ward. For infants receiving incubator care, both images are taken inside the transport incubator. The test duration is about 5 minutes.

1. b) Images are captured before kangaroo care, before and after transferring the infant to the ward (both images taken in the transport incubator if the infant is in incubator care).

1. c) Thermal images are taken before and after the insertion of an epicutaneous cannula.

1. d) For post-asphyxic infants undergoing therapeutic hypothermia, images are taken immediately before starting cooling on the therapeutic mattress, once midway through the cooling process; once immediately after reaching the target core temperature; then daily while in the hypothermic state; once immediately before the rewarming process, and every hour during rewarming until the desired core temperature is reached.

   Substudy 2:

2. a) In case of neonates waiting for surgeries lasting more than 30 minutes, thermal images are taken before the surgery; every 10 minutes during the operation; after surgery, following the same protocol as in Substudy 1.

2. b) Thermal images are taken before and after inserting a central cannula.

Parameters recorded in the substudies:

1. Blood tests, including c-reactive protein (CRP), procalcitonin (PCT), blood count, glucose, bilirubin, thyroid hormones, urea, creatinine, glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), and blood gas, as part of routine blood sampling.
2. Rectal core temperature, as well as episodes of shivering or heat production.
3. Changes in body temperature during surgery along with other routinely measured physiological parameters (e.g., blood pressure, respiratory indicators).
4. Type and dosage of anesthetics used, as well as any side effects (e.g., post-surgery vomiting).
5. Additional parameters such as gestational age, Apgar score, birth weight, body weight at the time of examination, and environmental temperature (e.g., clinic, incubator, operating room).

Examination process:

The parents/guardians/legal representatives of the selected patients will be provided with detailed information, and consent forms will be signed by them.

• Study Type: Observational
• Enrollment (Estimated): 100

Contacts and Locations

• Study Contact: Name: András Garami, MD, PhD; Phone Number: 38607 +3672536000; Email: andras.garami@aok.pte.hu
• Study Contact Backup: Name: Kata Fekete, MSc; Phone Number: 38604 +3672536000; Email: kata.fekete@aok.pte.hu

Study Locations

• Hungary
  • Baranya
    • Pécs, Baranya, Hungary, 7624
      • Recruiting
      • University of Pécs, Department of Obstetrics and Gynaecology
      • Contact: Simone Funke, MD, PhD; Phone Number: +3672536370; Email: funke.simone@pte.hu
      • Contact: Gergely Stankovics, MD; Email: gergely.stankovics@pte.hu
      • Contact: Simone Funke, MD, PhD
      • Contact: Gergely Stankovics, MD
    • Pécs, Baranya, Hungary, 7624
      • Recruiting
      • University of Pécs, Department of Paediatrics
      • Contact: Tamás Kövesi, MD, PhD; Phone Number: +3672535-832; Email: tamas.kovesi@pte.hu
      • Contact: Zsolt Fehér, MD; Phone Number: +3672535-832; Email: zsolt.feher@pte.hu
      • Contact: Tamás Kövesi, MD, PhD
      • Contact: Zsolt Fehér, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Study population consist of randomly chosen preterm and full-term neonates.

Description

Inclusion Criteria:

• For Substudy 1: Patients admitted to the Neonatal Intensive Care Unit at the University of Pécs, Department of Obstetrics and Gynaecology (premature infants or those in neonatal intensive care).
• For Substudy 2: Patients under 2 years of age undergoing elective surgery lasting more than 30 minutes at the University of Pécs, Department of Paediatrics.
• For both substudies: Written consent for participation in the study has been provided by the patient's parent, guardian, or legal representative.

Exclusion Criteria:

• For both substudies: If the patient cannot be mobilized (e.g., during the post-operative phase of abdominal or thoracic surgery; presence of chest tubes for pneumothorax or other reasons; hemodynamic instability; need for continuous electrocardiogram (ECG) monitoring; or use of an external pacemaker).
• The patient's parent, guardian, or legal representative does not consent to the study or withdraws their consent at any point.
• For Substudy 2: if the patient is older than 2 years.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Preterm neonates; Group of neonates who were born before the 37th gestational week.
Full-term neonates; Group of neonates who were born after the 37th gestational week.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Temperature data from the back of neonates revealing brown adipose tissue activity	Primary objective (Primary endpoint): The thermogram analysis may reveal reduced brown adipose tissue activity in preterm infants, which could contribute to their increased susceptibility to hypothermia during surgeries and intensive care. The temperature values of the head, brown fat, and trunk will be recorded in degrees of Celsius (°C) with thermal imaging. Their difference (e.g., brown fat temperature minus trunk temperature) will be used as a measure of brown fat activity also expressed in °C.	2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Concentration and count of special laboratory parameters in connection with thermogenesis in neonates	Secondary objective (Secondary endpoint): Blood test parameters of the newborns will be determined by the accredited Medical Testing Laboratory at the Clinical Centre, University of Pecs. These include blood cell counts [red blood cells (T/l), white blood cells (G/l), and platelets (G/l)], hemoglobin (g/l), hematocrit (%), glucose (mmol/l), bilirubin (µmol/l), thyroid hormones (mIU/l), urea (µmol/l), creatinine (µmol/l), CRP (mg/l), AST (IU/l), ALT (IU/l), GGT (IU/l), LDH (IU/l), PCT (0,5 ng/ml). They will be used to assess correlations between brown fat activity (see Primary Outcome Measure) and blood levels of a given blood parameter.	3 years
Blood cell counts	Level of red blood cells in T/l, white blood cells in G/l, and platelets in G/l.	3 years
Hemoglobin level	Hemoglobin level in g/l	3 years
Hematocrit level	Hematocrit level in %.	3 years
Glucose level	Glucose level in mmol/l.	3 years
Liver fuction	bilirubin in µmol/l, AST in IU/l, ALT in IU/l, GGT in IU/l, LDH in IU/l.	3 years
Kidney function	urea in µmol/l, creatinine in µmol/l.	3 years
Thyroid function	thyroid hormones in mIU/l (TSH, T3, T4).	3 years
Inflammatory markers	CRP in mg/l and PCT in ng/ml.	3 years

Collaborators and Investigators

• Sponsor: University of Pecs
• Investigators: Principal Investigator: Tamás Kövesi, MD, PhD, University of Pecs, Department of Anaesthesiology and Intensive Therapy; Principal Investigator: András Garami, MD, PhD, University of Pecs, Institute for Translational Medicine; Principal Investigator: Simone Funke, MD, PhD, University of Pécs, Department of Obstetrics and Gynaecology

Publications and helpful links

General Publications

• Lunze K, Hamer DH. Thermal protection of the newborn in resource-limited environments. J Perinatol. 2012 May;32(5):317-24. doi: 10.1038/jp.2012.11. Epub 2012 Mar 1.
• Nedergaard J, Cannon B. Brown adipose tissue as a heat-producing thermoeffector. Handb Clin Neurol. 2018;156:137-152. doi: 10.1016/B978-0-444-63912-7.00009-6.
• Symonds ME, Pope M, Sharkey D, Budge H. Adipose tissue and fetal programming. Diabetologia. 2012 Jun;55(6):1597-606. doi: 10.1007/s00125-012-2505-5. Epub 2012 Mar 9.
• Silverman WA, Sinclair JC. Temperature regulation in the newborn infant. N Engl J Med. 1966 Jan 13;274(2):92-4 contd. doi: 10.1056/NEJM196601132740207. No abstract available.
• Knobel R, Holditch-Davis D. Thermoregulation and heat loss prevention after birth and during neonatal intensive-care unit stabilization of extremely low-birthweight infants. J Obstet Gynecol Neonatal Nurs. 2007 May-Jun;36(3):280-7. doi: 10.1111/j.1552-6909.2007.00149.x.
• Lidell ME. Brown Adipose Tissue in Human Infants. Handb Exp Pharmacol. 2019;251:107-123. doi: 10.1007/164_2018_118.

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2024
• Primary Completion (Estimated): September 1, 2027
• Study Completion (Estimated): July 1, 2029

Study Registration Dates

• First Submitted: January 25, 2025
• First Submitted That Met QC Criteria: January 25, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 18, 2025
• Last Verified: October 1, 2024

More Information

Terms related to this study

• Keywords: preterm; infant; newborn; neonate; brown adipose tissue; neonatal hypothermia; nonshivering thermogenesis
• Additional Relevant MeSH Terms: Body Temperature Changes; Hypothermia
• Other Study ID Numbers: BM/17552-3/2024; NKFIH-FK-138722 (Other Grant/Funding Number: National Research, Development and Innovation Office)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No