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Preventing hypothermia at birth in preterm babies: at a cost of overheating some?
  1. T Newton,
  2. M Watkinson
  1. Neonatal Unit, Birmingham Heartlands Hospital, Birmingham, UK; michael.watkinson{at}heartsol.wmids.nhs.uk

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    In the Epicure study, the odds ratio of death before discharge for babies whose temperature on admission to the neonatal unit was > 35°C was 0.58 (95% confidence interval (CI) 0.39 to 0.85) compared with those with lower temperatures.1 In 2001, we therefore introduced a policy of wrapping neonates < 30 weeks gestation in polythene bags at birth without first drying them. Temperatures on admission to the neonatal unit after the introduction of this policy were compared with those of historical controls of < 30 weeks gestation admitted unwrapped between 1996 and 2000. The admission temperatures were analysed by stepwise multiple regression against being “bagged” or not, time to admission to the unit, birth weight, gestation, mode of delivery, month of delivery, and maternal temperature. Significant coefficients of variation existed between admission temperature and:

    • being bagged +0.35°C (0.09 to 0.62) (coefficient, 95% CI);

    • time to admission −0.02°C (−0.01 to −0.03) per minute;

    • birth weight +0.07°C (0.02 to 0.1) per 100 g;

    • gestation +0.0007°C (0.0002 to 0.001) °C per week.

    Thus “bagging” increased admission temperatures by 0.35°C, which is rather less than the rise of 1.9°C in babies < 28 weeks gestation reported in a previous study.2

    Table 1 shows that, in the comparable groups, this rise of 0.35°C resulted in a significant reduction in incidence of hypothermia (< 35.5°C) in “bagged” babies. However, significantly more of them (12%) were hyperthermic (> 37°C), a phenomenon previously reported but not discussed.2 The risks of hyperthermia are less well defined than those of hypothermia, but it may increase the risk of neurological damage, particularly after ischaemia.3 The technique of wrapping babies in polythene bags would seem to benefit very preterm babies, although we may yet have to learn to use it appropriately.

    Table 1

    Incidence of hypothermia and hyperthermia in control babies and babies wrapped in polythene bags (study group)

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