Heat loss prevention for preterm infants in the delivery room. Heat Loss Prevention (HeLP) in the delivery room: A randomized controlled trial of polyethylene occlusive skin wrapping in very preterm infants. Rewarming preterm infants on a heated, water filled mattress. Providing warmth for preterm babies by a heated, water filled mattress.
Preterm infants are prone to hypothermia immediately following birth. Among other factors, excessive evaporative heat loss and the relatively cool ambient temperature of the delivery room may be important contributors. Most infants <29 weeks gestation had temperatures <36.4 degrees C on admission to our neonatal unit (NICU). Therefore we conducted a randomized, controlled trial to evaluate the effect of placing these infants in polyurethane bags in the delivery room to prevent heat loss and reduce the occurrence of hypothermia on admission to the NICU.
                After parental consent was obtained, infants expected to be <29 weeks gestation were randomized to intervention or control groups just prior to their birth. Infants randomized to the intervention group were placed in polyurethane bags up to their necks immediately after delivery before being dried. They were then resuscitated per NRP guidelines, covered with warm blankets, and transported to the NICU, where the bags were removed and rectal temperatures were recorded. Control infants were resuscitated, covered with warm blankets, and transported without being placed in polyurethane bags. Delivery room temperatures were recorded so this potentially confounding variable could be assessed.
                Intervention patients were less likely than control patients to have temperature < 36.4 degrees C on admission , 44 vs 70% (p<0.01) and the intervention group had a higher mean admission temperature, 36.5 degrees C vs 36.0 degrees C (p<0.003). This effect remained significant (p<0.0001) when delivery room temperature was controlled in analysis. Warmer delivery room temperatures (>/=26 degrees C) were associated with higher admission temperatures in both intervention and control infants, but only the subgroup of intervention patients born in warmer delivery rooms had a mean admission temperature >36.4 degrees C.
                Placing infants <29 weeks gestation in polyurethane bags in the delivery room reduced the occurrence of hypothermia and increased their NICU admission temperatures. Maintaining warmer delivery rooms helped but was insufficient in preventing hypothermia in most of these vulnerable patients without the adjunctive use of the polyurethane bags. To determine if polyethylene occlusive skin wrapping of very preterm infants prevents heat loss after delivery better than conventional drying and to evaluate if any benefit is sustained after wrap removal.
                This was a randomized controlled trial of infants <28 weeks' gestation. The experimental group was wrapped from the neck down. Only the head was dried. Control infants were dried completely. Rectal temperatures were compared on admission to the neonatal intensive care unit immediately after wrap removal and 1 hour later.
                Of 55 infants randomly assigned (28 wrap, 27 control), 2 died in the delivery room and 53 completed the study. Wrapped infants had a higher mean rectal admission temperature, 36.5 degrees C (SD, 0.8 degrees C), compared with 35.6 degrees C (SD, 1.3 degrees C) in control infants ( P = .002). One hour later, mean rectal temperatures were similar in both groups (36.6 degrees C, SD, 0.7 degrees C vs 36.4 degrees C, SD, 0.9 degrees C, P = .4). Size at birth was an important determinant of heat loss: Mean rectal admission temperature increased by 0.21 degrees C (95% CI, 0.04 to 0.4) with each 100-g increase in birth weight.
                Polyethylene occlusive skin wrapping prevents rather than delays heat loss at delivery in very preterm infants. Sixty low birthweight infants (1000-2000 g) admitted to a neonatal care unit in Turkey were studied. Those not requiring intensive care were randomly assigned for treatment either in a cot on a heated, water filled mattress kept at 37 degrees C (n = 28) or in air heated incubators with a mean air temperature of 35 degrees C (n = 32). On admission 53 (88.3%) of the infants had body temperatures between 30 degrees and 36 degrees C. There was good correlation between axillary and rectal temperatures in the infants while they were hypothermic. Normal temperatures were achieved within the first day and remained within this range during the subsequent days after admission in all the infants treated on the heated, water filled mattress, whereas they were not achieved until three days later in the incubator group. The neonatal mortality among those treated on the heated, water filled mattress was 21%, and among those treated in the incubator 34%. The heated, water filled mattress provides a good alternative to skin to skin contact with the mother, and to the use of a complex and expensive incubator for rapidly attaining and maintaining normal temperatures in the low birthweight newborn. Seventeen healthy preterm babies had extra warmth provided in their cots by thermocontrolled, heated, water filled mattresses. As controls 17 babies of the same weight were nursed in air heated incubators. Both groups were studied for three weeks. No differences were found in minimal oxygen consumption (measured by indirect calorimetry), rectal and mean skin temperatures, or in daily weight gain. The babies were kept just as warm on the heated, water filled mattresses as in air heated incubators but the mattresses had the advantage of giving the mothers easy access to their babies.
Plastic wraps or bags, plastic caps, SSC and transwarmer mattresses all keep preterm infants warmer leading to higher temperatures on admission to neonatal units and less hypothermia. However, the small numbers of infants and studies and the absence of long-term follow-up mean that firm recommendations for clinical practice cannot be given.