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

Abstract

Evidence of moderate quality shows that use of plastic wraps or bags compared with routine care led to higher temperatures on admission to NICUs with less hypothermia, particularly for extremely preterm infants. Thermal mattresses and SSC also reduced hypothermia risk when compared with routine care, but findings are based on two or fewer small studies. Caution must be taken to avoid iatrogenic hyperthermia, particularly when multiple interventions are used simultaneously. Limited evidence suggests benefit and no evidence of harm for most short-term morbidity outcomes known to be associated with hypothermia, including major brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotising enterocolitis, and nosocomial infection. Many observational studies have shown increased mortality among preterm hypothermic infants compared with those who maintain normothermia, yet evidence is insufficient to suggest that these interventions reduce risk of in-hospital mortality across all comparison groups. Hypothermia may be a marker for illness and poorer outcomes by association rather than by causality. Limitations of this review include small numbers of identified studies; small sample sizes; and variations in methods and definitions used for hypothermia, hyperthermia, normothermia, routine care, and morbidity, along with lack of power to detect effects on morbidity and mortality across most comparison groups. Future studies should: be adequately powered to detect rarer outcomes; apply standardised morbidity definitions; focus on longer-term outcomes, particularly neurodevelopmental outcomes.

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

“…Heating and humidification of gases used for stabilisation is ideal in terms of preventing heat loss [52]. Immediate wrapping in a polythene bag under a radiant warmer also reduces heat loss [53], and increasing the environmental temperature in the delivery room to around 26°C is also recommended for babies less than 28 weeks [33]. Heated, humidified oxygen delivered by high-flow nasal cannula (HFNC) has also been studied as a primary mode of respiratory support but was inferior to CPAP in terms of failure, with babies randomised to HFNC often needing rescue with CPAP to prevent intubation [54].…”

“…After birth, immediate wrapping in a polythene bag under a radiant warmer reduces heat loss [53]. Servo-controlled incubators with skin temperature set at 36.5°C decrease neonatal mortality [155].…”

Obstetric strategies to reduce blindness from retinopathy of prematurity in infants born preterm

“…Preterm infants rapidly lose heat, but this can be effectively prevented by placing the infant's body in a plastic bag or using occlusive wrapping . As well as reducing hypothermia, there is some evidence that major morbidities, including ROP, are also reduced …”

Polyethylene versus cotton cap as an adjunct to body wrap in preterm infants

“…The head comprises 20.8% of the total body surface area, therefore heat lost from the head represents a substantial proportion of the total heat loss . As per current practice, the head is dried using linen and then covered with a cotton cap, but cotton caps are not effective in reducing hypothermia . Trevisanuto et al .…”

“…14 As per current practice, the head is dried using linen and then covered with a cotton cap, but cotton caps are not effective in reducing hypothermia. 15 Trevisanuto et al compared three groups of preterm infants at <29 weeks of gestation: (i) plastic cap (head covered with plastic cap without prior drying and body dried with linen); (ii) body wrap (body wrapped with plastic without drying and head dried); and (iii) control (body and head dried). Admission hypothermia was reported in 43% of the plastic cap group, 62% of the body wrap group and 90% of the control group.…”