Thermal management for premature births

Abstract

This paper reports an audit of the effect on admission temperatures of using occlusive polyethylene wrap applied immediately after the birth of extremely premature infants. Use of occlusive polyethylene wrap during the early postnatal management of the premature infant reduces evaporative and convective heat loss. Retrospective pre-intervention audit was carried out, followed by the introduction of occlusive polyethylene wrap for thermal management during resuscitation and early stabilization. Prospective post-intervention audit was then performed. The pre-intervention (control) group infants were immediately dried with prewarmed towels and resuscitated under radiant heat. Infants in the intervention group were managed under radiant heat, were not dried but were immediately enclosed in an occlusive polyethylene wrap. The demographic characteristics of the two groups were comparable. Use of occlusive polyethylene wrap resulted in higher admission temperatures for infants less than 27 weeks gestation (z=108.50, P<0.01). There was no statistically significant improvement in admission temperatures for 27-29 week infants. The rate of hypothermia on admission (<35.6 degrees C per axilla) was lower in the intervention group (chi(2)=5.12, d.f.=1, P=0.02), but more infants recorded temperatures exceeding 37.2 degrees C during the first 12 hours (chi(2)=23.45, d.f.=1, P<0.01). There were no other adverse effects noted. Use of occlusive polyethylene wrap improved admission temperatures for infants less than 27 weeks gestation. This intervention is easy to implement and does not interfere with resuscitation. However, removal of the wrap should be considered following admission to a closed care system in the neonatal intensive care unit because, in the intervention group, hyperthermia in the first 12 hours was a potential side effect.