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Evidence summaries

Prevention of Hypothermia at Birth in Preterm and/or Low Birthweight Babies

Plastic wraps or bags, skin-to-skin care and transwarmer mattresses appear to be effective for preventing heat loss in preterm babies, leading to higher temperatures on admission to neonatal units and less hypothermia. Level of evidence: "B"

Comment: The quality of evidence is downgraded by study limitations (unclear blinding of outcome assessment).

A Cochrane review [Abstract] 1 included 25 studies with a total of 2433 subjects.

Barriers to heat loss (18 studies)

  • Plastic wraps or bags were effective in reducing heat losses in infants (table T1). There was insufficient evidence to suggest that barriers reduce the risk of death within hospital stay or other major morbidities, with the exception of reducing risk of pulmonary haemorrhage.

Plastic wrap or bag compared with routine care in preterm and/or low birth weight infants

OutcomeRelative effect (95% CI)Risk with routine careRisk with intervention - plastic wrap or bag (95% CI)No. of participants (studies) Quality of evidence
Core body temperature (°C) on admission to NICU or up to 2 hours after birth-34.80 to 36.2MD 0.58 higher (0.50 higher to 0.66 higher)1633 (13) Moderate
Hypothermia on admission to NICU: core body temperature < 36.5°C or skin temperature < 36°C Study populationRR 0.67 (0.62 to 0.72)738 per 1000495 per 1000 (458 to 531)1417 (10) Moderate
Hyperthermia on admission to NICU: core body temperature > 37.5°CRR 3.91 (2.05 to 7.44)12 per 100046 per 1000 (24 to 87)1523 (12) Moderate
Major brain injury (within hospital stay)RR 0.78 (0.47 to 1.27)62 per 100049 per 1000 (29 to 79)1100 (5) Moderate
Pulmonary haemorrhage (within hospital stay)RR 0.60 (0.38 to 0.95)112 per 100067 per 1000 (43 to 106)796 (1) Moderate
Mortality (death within hospital stay or at 6 months' corrected gestation)RR 0.91 (0.73 to 1.15)168 per 1000153 per 1000 (123 to 194)1447 (10) Moderate

External heat sources (2 studies)

  • Skin-to-skin care was shown to be effective in reducing the risk of hypothermia when compared to conventional incubator care for infants 1200 to 2199 g birthweight (RR 0.09, 95% CI 0.01 to 0.64; NNT 2, 95% CI 1 to 4; 1 study, n=31). The transwarmer mattress significantly reduced the incidence of hypothermia on admission to NICU in very low birth weight infants (RR 0.30, 95% CI 0.11 to 0.83; NNT 2, 95% CI 1 to 4; 1 study, n=24).

    References

    • McCall EM, Alderdice F, Halliday HL et al. Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2018;(2):CD004210. [PubMed]

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