Effect of polyethylene occlusive skin wrapping on heat loss in very low birth weight infants at delivery: A randomized trial,☆☆,

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Abstract

Objective: Significant evaporative heat loss in the very low birth weight infant can occur in the delivery room. We investigated the effect of polyethylene wrap applied immediately at birth (without drying) on rectal temperature measured at nursery admission. Study design: Sixty-two consecutive infants delivered at <32 weeks’ gestation were stratified by gestational age and randomly allocated to resuscitation with polyethylene wrap. All infants were resuscitated under radiant warmers. Wraps were removed on nursery admission. Rectal temperature was taken by digital electronic thermometer. Results: Fifty-nine of 62 recruited infants completed the study. Maternal temperature, delivery room temperature, transfer-incubator temperature, and time to admission were recorded. Use of occlusive wrapping resulted in a significantly higher admission rectal temperature in infants <28 weeks’ gestation (difference in means = 1.9°C, P < .001). No significant difference was seen in admission rectal temperature in infants of 28 to 31 weeks’ gestation (difference in means = 0.17°C, P = .47). All 5 deaths were in the nonwrap group (vs wrap, P = .04); their mean temperature was 35.1°C versus 36.5°C in survivors (P = .001). Conclusions: Occlusive wrapping of very low birth weight infants at delivery reduces postnatal temperature fall. This may result in a decreased mortality rate. (J Pediatr 1999;134:547-51)

Section snippets

METHODS

We conducted a randomized clinical trial to compare the effects of wrapping or not wrapping infants born at <31 weeks’ gestation at the Grace Hospital (later the IWK Grace Health Centre) in Halifax, Nova Scotia, from January 1, 1995, to July 31, 1996. The study population consisted of consecutively born infants of 31 completed weeks of gestation or less. Each subject was recruited when the neonatal team was called to attend the delivery. Exclusion criteria were major congenital anomalies with

RESULTS

A total of 62 infants were recruited (23 boys and 29 <28 weeks’ gestation). Of these, 59 infants completed the study (Table I).One infant was excluded because no rectal temperature was recorded. Two infants were excluded because of an imperforate anus.

Younger and smaller infants were more dependent on the wrapping than older infants for maintaining a higher rectal temperature (Table I and Fig 2).

. Rectal temperature plotted against birth weight for 2 groups of premature infants (wrap = closed

DISCUSSION

Polyethylene wrap applied immediately after birth reduces the postnatal fall in temperature of very immature infants by reducing evaporative and convective heat loss. This is more effective than conventional drying and exposure, when both methods are applied under radiant heat.

We found a difference in the effectiveness of the wrap on newborns of different gestational ages. Wrapping was significantly more effective in preventing heat loss in the infants born between 23 and 27 completed weeks of

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  • Cited by (0)

    Supported by the IWK Grace Research Foundation, Halifax NS.

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    Reprint requests: R.K. Whyte, MB, IWK Grace Health Centre, 5980 University Ave, Halifax NS Canada B3J 3G9.

    0022-3476/99/$5.00 + 0  9/21/97132

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