Elsevier

The Journal of Pediatrics

Volume 166, Issue 2, February 2015, Pages 245-250.e1
The Journal of Pediatrics

Original Article
Initial Respiratory Support with Cold, Dry Gas versus Heated Humidified Gas and Admission Temperature of Preterm Infants

https://doi.org/10.1016/j.jpeds.2014.09.049Get rights and content

Objective

To assess whether the addition of heated humidified gas (HHG) at delivery and until neonatal unit arrival improved admission temperatures of preterm infants.

Study design

This multicenter, randomized controlled trial was performed in New Zealand and The Netherlands. Infants <32 weeks' gestation who required respiratory support after delivery were randomized to either cold, dry gas or HHG from birth. Standard measures to prevent hypothermia included heated delivery rooms, the use of radiant warmers, body wrap, and head covering. The primary outcome was axillary temperature in the normothermic (36.5-37.5°C) range on admission to a neonatal intensive care unit. Secondary outcomes were measures of respiratory support and neonatal morbidities. The effect of humidification was analyzed by the use of logistic regression.

Results

Of 203 randomized infants, 100 received HHG (humidifier set to 37°C) and 103 received cold, dry gas. In the HHG group, 69 (69%) were normothermic compared with 57 (55%) in the cold, dry gas group (unadjusted OR 1.8, 95% CI 1.01-3.19). A greater number of infants <28 weeks were normothermic on admission in the HHG group (24/35; ie, 69%) compared with the cold, dry gas group (16/38; ie, 42%; P = .03). In addition, 2 (2%) infants in the HHG group had admission temperatures <35.5°C compared with 12 (12%) in the cold, dry gas group (P = .007). Respiratory and short-term outcomes were not different.

Conclusion

Adding HHG during respiratory support in preterm infants from birth increased the incidence of normothermia at admission.

Section snippets

Methods

A nonblinded, randomized controlled trial was performed in 2 centers: Middlemore Hospital, Auckland, New Zealand (NZ), and Leiden University Medical Center, Leiden, The Netherlands (NL). Preterm infants <32 weeks' gestation that were deemed by the clinical team to require respiratory support at delivery were eligible for the study. Infants were randomized to either unconditioned, cold, dry gas, or HHG during respiratory support at birth and during transport. Initial respiratory support was

Results

Analysis was performed on 103 infants who received cold, dry gas and 100 who received HHG during respiratory support; 105 infants were entered in NZ and 98 in NL (Figure 1). There were no differences in baseline characteristics (Table I). The median humidifier temperature as recorded in NZ was 36.7°C (IQR 36.2-37.0°C) before birth, and there were no instances in which the humidifier ran dry, nor was there loss of gas flow/pressure through the circuit. Two infants who were randomized did not

Discussion

In this randomized controlled trial, preterm infants receiving respiratory support via a T-piece resuscitator in the humidification arm were supplied with HHG from birth.

We found that there were more normothermic infants in the HHG group on admission to the neonatal unit. The reduction in hypothermia in the trial was of the same magnitude (35%) as the previous observational study.7 In addition, we observed that humidification was more effective in preventing more severe degrees of hypothermia,

References (17)

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Fisher & Paykel Healthcare (Auckland, New Zealand) provided partial funding for a research nurse and humidifier circuits for the study. A.teP. is supported by The Netherlands Organisation for Health Research and Development, part of the Innovational Research Incentives Scheme Veni-Vidi-Vici (91612027). The authors declare no conflicts of interest.

Registered with the ANZCTR (Australia New Zealand Clinical Trials Registry): 12609000694213.

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