Hypothermia In Preterm Infants Research Articles

Total Body Polyethylene Wraps for Preventing Hypothermia in Preterm Infants: A Randomized Trial

To evaluate whether a polyethylene total body wrapping (covering both the body and head) is more effective than conventional treatment (covering up to the shoulders) in reducing perinatal thermal losses in very preterm infants. This was a multicenter, prospective, randomized, parallel 1:1, unblinded, controlled trial of infants<29 weeks' gestation age, comprising two study groups: experimental group (total body group; both the body and head covered with a polyethylene occlusive bag, with the face uncovered) and control group (only the body, up to the shoulders, covered with a polyethylene occlusive bag). The primary outcome was axillary temperature on neonatal intensive care unit admission immediately after wrap removal. One hundred randomly allocated infants (50 in the total body group and 50 controls) completed the study. Mean axillary temperature on neonatal intensive care unit admission was similar in the two groups (36.5±0.6°C total body vs 36.4±0.8°C controls; P=.53). The rate of moderate hypothermia (temperature<36°C) was 12% in the total body group and 20% in the control group (P=.41). Three subjects in each group (6.0%) had an axillary temperature>37.5°C on admission, and one subject in control group had an axillary temperature>38°C. Total body wrapping is comparable with covering the body up to the shoulders in preventing postnatal thermal losses in very preterm infants.

Reducing Hypothermia in Preterm Infants Following Delivery

Moderate hypothermia (temperature <36°C) at birth is common in premature infants and is associated with increased mortality and morbidity. A multidisciplinary practice plan was implemented to determine in premature infants <35 weeks old whether a multifaceted approach would reduce the number of inborn infants with an admitting axillary temperature <36°C by 20% without increasing exposure to a temperature >37.5°C. The plan included use of occlusive wrap a transwarmer mattress and cap for all infants and maintaining an operating room temperature between 21°C and 23°C. Data were obtained at baseline (n = 66), during phasing in (n = 102), and at full implementation (n = 193). Infant axillary temperature in the delivery room (DR) increased from 36.1°C ± 0.6°C to 36.2°C ± 0.6°C to 36.6°C ± 0.6°C (P < .001), and admitting temperature increased from 36.0°C ± 0.8°C to 36.3°C ± 0.6°C to 36.7°C ± 0.5°C at baseline, phasing in, and full implementation, respectively (P < .001). The number of infants with temperature <36°C decreased from 55% to 6.2% at baseline versus full implementation (P < .001), and intubation at 24 hours decreased from 39% to 17.6% (P = .005). There was no increase in the number of infants with a temperature >37.5°C over time. The use of occlusive wrap, mattress, and cap increased from 33% to 88% at baseline versus full implementation. Control charts showed significant improvement in DR ambient temperature at baseline versus full implementation. The practice plan was associated with a significant increase in DR and admitting axillary infant temperatures and a corresponding decrease in the number of infants with moderate hypothermia. There was an associated reduction in intubation at 24 hours. These positive findings reflect increased compliance with the practice plan.

Heat Loss Prevention (Help) After Birth in Preterm Infants Using Vinyl Isolation Bag or Polyethylene Wrap

To examine the effects of using vinyl isolation bags or polyethylene wrap for the prevention of postnatal hypothermia in preterm infants at ≤ 32 weeks gestation. A prospective, randomized controlled trial. The neonatal intensive care unit (NICU) of the Istanbul Faculty of Medicine in Turkey. Fifty-nine preterm infants. Participants were randomly assigned to either the vinyl isolation-bag experimental group (n = 22) or the polyethylene-wrap control group (n = 37). Infant body temperature was measured at four time points after birth. Loss of body temperature was significantly less in the vinyl isolation-bag group during the first 60 minutes after birth (p = .041). Body temperature decreased by 1.41 ± 1.65 °C in the vinyl isolation-bag group and 2.75 ± 1.68 °C in the polyethylene wrap group. Body temperature was significantly less in the polyethylene wrap group compared to the vinyl isolation-bag group at birth to 60 minutes (p = .004). Wrapping preterm infants of gestational age ≤ 32 weeks in vinyl bags immediately after birth is associated with lower incidences of hypothermia.

Initial Optimal Body Temperature in Preterm Infants

Hypothermia in preterm infants on admission to neonatal intensive care units remains an issue. Initial hypothermia was found to be one of the important risk factors for increased mortality and morbidity in preterm infants. Smaller size and more immaturity are associated with increased vulnerability to the cold environment of delivery rooms. To prevent heat loss after birth, the treat ment recommendations that were recently added are increasing delivery room temperature and immediate use of plastic covering and hats. This review summarizes up-to-date studies of the background and strategies for preventing hypothermia of preterm infants.

Reducing hypothermia in preterm infants with polyethylene wrap

Occlusive plastic applied immediately after birth to reduce evaporative heat loss has been proven effective in preterm infants <28 weeks' gestation. However its effectiveness on preterm infants >28 weeks' gestation has not been shown. This study aimed to determine the effect of occlusive wrap at birth on the temperature at neonatal intensive care unit (NICU) admission among infants of greater than or equal to 24 weeks' and less than 34 weeks' gestation. Study infants were randomly assigned to "wrap" or "control" groups. Newborns in the wrap group were wrapped with polyethylene plastic sheets within the first min after birth. Infants randomized to the control group were dried immediately after birth with warmed towels under a warmer, according to the guidelines of Neonatal Resuscitation. Infants' axillary temperatures were measured on admission to the NICU, and after having been stabilized in incubators in the NICU. A total of 110 infants were recruited into the study. The mean admission temperature was significantly higher in the wrap group (35.8 vs 34.8°C, P < 0.01). Admission hypothermia (axillary temperature <36.5°C) was present in 38 (78%) and 58 (98%) infants in the wrap and control groups, respectively. Among infants of <28 weeks' gestation, the post-stabilization temperature was significantly higher in the wrap group. Wrapping premature infants with gestational age <34 weeks in polyethylene plastics immediately after birth is associated with lower incidence of hypothermia.

Can we improve delivery room monitoring for newborns? A novel photoplethysmographic heart rate monitor evaluated among stable nicu infants

BackgroundHeart rate (HR) is considered the most reliable indicator of successful newborn resuscitation. Current recommended assessment is by auscultation but this is subject to human error1 and can interrupt resuscitation....

Hypothermia in very low birth weight infants: distribution, risk factors and outcomes

The objective of this study was to study the epidemiology of neonatal hypothermia in preterm infants using World Health Organization (WHO) temperature criteria. A population-based cohort of 8782 very low birth weight (VLBW) infants born in California neonatal intensive care units in 2006 and 2007. Associations between admission hypothermia and maternal and neonatal characteristics and outcomes were determined using logistic regression. In all, 56.2% of infants were hypothermic. Low birth weight, cesarean delivery and a low Apgar score were associated with hypothermia. Spontaneous labor, prolonged rupture of membranes and antenatal steroid administration were associated with decreased risk of hypothermia. Moderate hypothermia was associated with higher risk of intraventricular hemorrhage (IVH). Moderate and severe hypothermic conditions were associated with risk of death. Hypothermia by WHO criteria is prevalent in VLBW infants and is associated with IVH and mortality. Use of WHO criteria could guide the need for quality improvement projects targeted toward the most vulnerable infants.