Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants

McCall, Emma; Alderdice, Fiona; Halliday, Henry L.; Jenkins, John; Vohra, Sunita

doi:10.1002/14651858.cd004210.pub4

Cited by 90 publications

(57 citation statements)

References 114 publications

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“…Low birth weight greatly increases the risk of hypothermia, and is most common in developing countries [5]. Recommended thermal care practices include immediate drying and wrapping, skin-to-skin contact after birth, delaying bathing until the second day of life, appropriate dressing of the baby and immediate and frequent breastfeeding [8–13]. …”

Section: Introductionmentioning

confidence: 99%

Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change

Shamba

Schellenberg

Hildon

et al. 2014

BMC Pregnancy Childbirth

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BackgroundHypothermia contributes to neonatal morbidity and mortality in low-income countries, yet little is known about thermal care practices in rural African settings. We assessed adoption and community acceptability of recommended thermal care practices in rural Tanzania.MethodsA multi-method qualitative study, enhanced with survey data. For the qualitative component we triangulated birth narrative interviews with focus group discussions with mothers and traditional birth attendants. Results were then contrasted to related quantitative data. Qualitative analyses sought to identify themes linked to a) immediately drying and wrapping of the baby; b) bathing practices, including delaying for at least 6 hours and using warm water; c) day to day care such as covering the baby’s head, covering the baby; and d) keeping the baby skin-to-skin. Quantitative data (n = 22,243 women) on the thermal care practices relayed by mothers who had delivered in the last year are reported accordingly.Results42% of babies were dried and 27% wrapped within five minutes of birth mainly due to an awareness that this reduced cold. The main reason for delayed wrapping and drying was not attending to the baby until the placenta was delivered. 45% of babies born at a health facility and 19% born at home were bathed six or more hours after birth. The main reason for delayed bathing was health worker advice. The main reason for early bathing believed that the baby is dirty, particularly if the baby had an obvious vernix as this was believed to be sperm. On the other hand, keeping the baby warm and covered day-to-day was considered normal practice. Skin-to-skin care was not a normalised practice, and some respondents wondered if it might be harmful to fragile newborns.ConclusionMost thermal care behaviours needed improving. Many sub-optimal practices had cultural and symbolic origins. Drying the baby on birth was least symbolically imbued, although resisted by prioritizing of the mothers. Both practical interventions, for instance, having more than one attendant to help both mother and baby, and culturally anchored sensitization are recommended.

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Section: Introductionmentioning

confidence: 99%

Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change

Shamba

Schellenberg

Hildon

et al. 2014

BMC Pregnancy Childbirth

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“…Practices that directly affect mortality and morbidity include antenatal steroids [4], gentle resuscitation at delivery [5], careful oxygen delivery and monitoring [6,7], pain control [8], avoidance of sepsis and hypothermia [9], better nutrition [10] and supportive care [11]. There are many reasons why care may not be adequate in neonatal intensive care units (NICUs) in LMICs including very low nurse-to-infant ratios, inadequate equipment to blend, deliver and monitor oxygen, and the fact that care is often by nurse assistants who have had limited training.…”

Section: Introductionmentioning

confidence: 99%

Educating Neonatal Nurses in Brazil: A Before-and-After Study with Interrupted Time Series Analysis

Gilbert

Darlow

Zin³

et al. 2014

Neonatology

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Background: Preterm birth contributes significantly to infant mortality and morbidity, including blindness from retinopathy of prematurity (ROP). Access to intensive neonatal care is expanding in many countries, but care is not always optimal, one factor being that nursing is often by inadequately trained nurse assistants. Objective: The aim of this study was to evaluate whether an educational package for nurses improves a range of outcomes including survival rates and severe ROP in 5 neonatal units in Rio de Janeiro, Brazil. Methods: The study design included an uncontrolled before-and-after study in 5 units, with interrupted time series analysis. Participatory approaches were used to develop a self-administered educational package for control of pain, oxygenation, infection, nutrition, and temperature and to improve supportive care (‘POINTS of Care'). Educational materials and DVD clips were developed and training skills of nurse tutors were enhanced. There were two 1-year periods of data collection before and after a 3-month period of self-administration of the education package. Results: Overall, 74% of 401 nurses and nurse assistants were trained. A total of 679 and 563 infants were included in the pre- and post-training periods, respectively. Despite improvement in knowledge and nursing practices, such as the delivery and monitoring of oxygen, there was no change in survival (pre-training 80%, post-training 78.2%), severe ROP (1.6 vs. 2.8%), sepsis (11.3 vs. 12.3 cases per 1,000 infant days) or other outcomes. Outcomes worsened over the pre-intervention period but the change to an improvement after the intervention was not statistically significant. During the study period many trained staff left the units, but few were replaced. Conclusions: Future studies need to focus on barriers to implementation, team building, leadership and governance, as well as the acquisition of knowledge and skills.

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“…30-40% RH). The use of cold dry gas may adversely affect lung function and increase the risk of hypothermia, which is an independent risk factor for mortality in preterm infants [4]. The use of dry ventilator gases has been shown to have a detrimental effect on airway epithelium, ciliary function, mucous viscosity and lung inflammation [5,6].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Practical Considerations for Heating and Humidifying Gases during Newborn Stabilisation: An in vitro Model

Owen

Dawson²,

Middleburgh³

et al. 2014

Neonatology

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Background: Gases for respiratory support at birth are typically ‘cold and dry', which may increase the risk of hypothermia and lung injury. Objectives: To determine the feasibility of using heated humidification from birth. Method: A humidifier targeting 37°C, a manual-fill chamber and a Neopuff Infant T-piece resuscitator and circuit were attached to a face mask and a manikin. Recordings using 20 ml H₂O for humidification and a flow of 10 l/min were undertaken. Temperature and relative humidity (RH) were recorded. Additional recordings were made, each with one alteration to baseline (50 ml H₂O for humidification, auto-fill chamber, a flow of 8 l/min, addition of circuit extension piece, warmed humidification H₂O, increased ambient temperature and targeting 31°C). The duration of heated humidification and the response to disconnecting the power were investigated. Results: The baseline circuit achieved 95% RH and 31°C in 3 min, >99% RH in 7 min and ≥35°C in 9 min. No circuit alterations resulted in faster gas conditioning. The extended length circuit and targeting 31°C reduced the maximum temperature achieved. A flow of 8 l/min resulted in slower heating and humidification. The baseline circuit delivered heated humidification for 39 min. Without power, the temperature and humidity fell below international standards in 3 min. Conclusion: Rapid gas conditioning for newborn stabilisation is feasible using the experimental set-up, ≥20 ml H₂O and a flow of 10 l/min. The circuit could be used immediately once switched on. Without power, conditioning is quickly lost. Investigation of the clinical effects of gas conditioning is warranted.

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Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants

Cited by 90 publications

References 114 publications

Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change

Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change

Educating Neonatal Nurses in Brazil: A Before-and-After Study with Interrupted Time Series Analysis

Feasibility and Practical Considerations for Heating and Humidifying Gases during Newborn Stabilisation: An in vitro Model

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