Objective ILCOR recommend polyethylene bags/wraps and a delivery room temperature (DRT) temperature of ≥26^oC for infants born at <28 weeks’ gestation (w).¹ Admission temperatures (AT) <36.5^oC are associated with increased mortality.² We evaluated our thermoregulatory practice and explored factors contributing to hypothermia in newborn preterm infants.

Methods A five month prospective audit of all inborn infants <32 w admitted to a tertiary NICU.

Results We analysed 36 infants: mean (SD) birthweight 1085(358)g, gestational age 28(2)w. Mean maternal temperature was 36.8(0.5)^oC but <36.5^oC in 33% of mothers. Mean DRT was 24.7(1.4)^oC; ≥26^oC in 9%, <24^oC in 30%. Infants born in the operating room had a significantly lower mean AT than infants born in labour ward (p = 0.03). Mean infant temperature on the resuscitaire (RT) was 36.8(0.5)^oC but <36.5^oC in 19% of infants. Of the 19%, mean RT was 36.1^oC (range ‘unrecordable’ -36.3^oC) and only two infants had a temperature >36.5^oC within one hour of admission. Regression analysis showed a strong association (48%) between RT and AT. Mean AT was 36.8(0.7)^oC; <36.5^oC in 36%, >37.5^oC in 14%. All infants <28 w and 42% of infants ≥28 w were stabilised in a wrap. Mean AT for those in wraps was 36.9(0.7)^oC and 36.5(0.6)^oC for those without wraps. In 41%, wraps were removed before checking AT.

Conclusion These data suggest that several factors affect AT, particularly DRT and RT. Improvements in clinical practice should include targeting DRTs >26^oC and checking AT before removing wraps. A multidisciplinary approach may improve thermoregulation in newborn preterm infants.

References

1. Perlman, et al. Part 11: Neonatal Resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010;122:S516–S538

2. Laptook, et al. Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics 2007;119;e643