Reducing heat loss at birth in very preterm infants

doi:10.1067/mpd.2000.107631

The Journal of Pediatrics

Volume 137, Issue 5, November 2000, Pages 739-740

https://doi.org/10.1067/mpd.2000.107631 Get rights and content

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To the Editor:

Evaporative heat loss during the first minutes of life may cause severe cooling in the very preterm infant. In a randomized trial, Vohra et al¹ showed that occlusive skin wrapping immediately after birth resulted in a higher rectal temperature in infants <28 weeks’ gestation. After seeing a poster presentation of that study,² we introduced the method in our nursery in summer 1997. Nine months later, we made the evaluation reported here.

In our unit, a newborn preterm infant is first stabilized

References (3)

S Vohra et al.
Effect of polyethylene occlusive skin wrapping on heat loss in very low birth weight infants at delivery: a randomized trial
J Pediatr
(1999)

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Cited by (32)

European Resuscitation Council Guidelines for Resuscitation 2015. Section 7. Resuscitation and support of transition of babies at birth
2015, Resuscitation
Citation Excerpt :
If the baby needs support in transition or resuscitation then place the baby on a warm surface under a preheated radiant warmer. All babies less than 32 weeks gestation should have the head and body of the baby (apart from the face) covered with polyethylene wrapping, without drying the baby beforehand, and also placed under a radiant heater.73,77,82,83 In addition, babies <32 weeks gestation, may require a combination of further interventions to maintain the temperature between 36.5 °C and 37.5 °C after delivery through admission and stabilisation.
Study protocol for multicentre randomized controlled trial of HeLP (Heat Loss Prevention) in the delivery room
2013, Contemporary Clinical Trials
Citation Excerpt :
Each participating institution submits a copy of their centre's initial Institutional Review Board approval and subsequent annual renewals to the VON HeLP Trial Coordinating Center. Research available at the time this study was planned demonstrates the effectiveness of occlusive skin wrap in reducing immediate postnatal heat loss however the data is underpowered to determine if wrapping is effective in preventing mortality in premature infants [13–16,19,20]. Hypothermia remains an independent risk factor for death in premature newborns [2,5–11] and therefore, the VON HeLP Trial seeks to determine the effectiveness of the occlusive skin wrap on preventing all-cause mortality.
Immediate postnatal hypothermia is an independent risk factor for death in premature newborns. Three randomized controlled trials (RCTs) and five historical controlled trials show statistically significant differences in admission temperature between infants wrapped in occlusive skin wrap and unwrapped infants. This paper presents a study protocol for The Vermont Oxford Network (VON) Heat Loss Prevention (HeLP) Trial, a multicentre RCT of two interventions (standard of care vs. occlusive wrap) that investigates the effect of polyethylene occlusive wrap applied immediately after birth on mortality in infants born 24 + 0/7 to 27 + 6/7 week gestation.
Inclusion criteria include: infants 24 + 0/7 to 27 + 6/7 weeks gestational age and a firm decision prior to birth to provide full resuscitative measures. Exclusion criteria comprise infants born with blistering skin conditions or congenital anomalies that are not covered by skin. The primary outcome measure is all-cause mortality until discharge from the hospital or at six months corrected gestational age. The secondary outcome measures include baseline and post-stabilization axillary temperatures, acidosis, hypotension, hypoglycaemia, seizures in the first 12 h, patent ductus arteriosus, and respiratory distress syndrome. Long-term follow-up at 18 to 24 months corrected age will be assessed with the combined risk of death and major neurosensory disability as the primary outcome.
Key covariates and protocol deviations are addressed and steps to monitor these are described. Wrapping may prove an inexpensive and easy method to benefit premature newborns in level I and II nurseries, in both developed and developing countries, as well as large tertiary care centres.
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada—355-2003
University of Alberta, Edmonton, Alberta, Canada—Pro00003810
Vermont Oxford Network, Burlington, Vermont, USA—CHRMS: M04-295
European Resuscitation Council Guidelines for Resuscitation 2010. Section 7. Resuscitation of babies at birth
2010, Resuscitation
Citation Excerpt :
Significantly preterm babies are likely to become hypothermic despite careful application of the traditional techniques for keeping them warm (drying, wrapping and placing under radiant heat).24 Several randomised controlled trials and observational studies have shown that placing the preterm baby under radiant heat and then covering the baby with food-grade plastic wrapping without drying them, significantly improves temperature on admission to intensive care compared with traditional techniques.25–27 The baby's temperature must be monitored closely because of the small but described risk of inducing hyperthermia with this technique.28
Applied physiology: Temperature control in the newborn infant
2006, Current Paediatrics
It has been known for centuries that warmth is important for the newborn. In the 1950s, randomized controlled trials showed that keeping babies warm significantly reduced neonatal mortality. Technology has improved our ability to keep even the most immature baby warm, but there is evidence that infants still become cold during resuscitation and that most units are not achieving the British Association of Perinatal Medicine/Royal College of Paediatrics and Child Health standard of an admission temperature of at least 36 °C. A low temperature on admission has been independently associated with increased mortality in the preterm infant. Preventing evaporation, with the use of a plastic bag, while the baby is on the resuscitaire can abolish hypothermia on admission. There are no studies that show any difference in outcome for preterm babies nursed in incubators compared with those under radiant heaters. Care must be taken to reduce the very high transepidermal water losses under radiant heaters. The way a baby interacts with its environment is always changing and, whatever temperature and humidity settings are first used, it is necessary to monitor the thermal balance continuously. The continuous measurement and display of a central and a peripheral temperature gives an early indication of cold stress before there is any fall in the baby's core temperature.
Neonatal thermoregulation
2006, Journal of Neonatal Nursing
Citation Excerpt :
Methods to keep these high-risk babies warm include kangaroo-mother care (skin-to-skin contact) (Ludington-Hoe et al., 2000; Christidis et al., 2003; Dodd, 2005; McCall et al., 2005; Cramer et al., 2005), heated water-filled mattresses (Green-Abate et al., 1994; Gray and Flenady, 2003; Gray et al., 2004; McCall et al., 2005), radiant heaters (Baumgart et al., 1981; Bell, 1983; Bell and Rios, 1983; Seguin and Vieth, 1996; Flenady and Woodgate, 2003; Christidis et al., 2003), and incubators (McCall et al., 2005). More recent studies have demonstrated the effectiveness of occlusive polyethylene wrap to improve admission temperatures and reduce insensible losses in premature infants (Knauth et al., 1989; Vohra et al., 1999, 2004; Bjorklund and Hellstrom-Westas, 2000; Bredemeyer et al., 2005). A Cochrane systematic review concludes that, during at least the first week after birth, low birth weight babies should be provided with a carefully regulated thermal environment that is near the thermoneutral point.
Thermoregulation is the ability to balance between heat production and heat loss in order to maintain body temperature within a certain normal range. The provision of a thermoneutral environment is an essential component of the immediate and longer term care of newborn infants. Cold stress and hyperthermia may have serious metabolic consequences for all newborns. In the preterm these consequences may be devastating and may increase both morbidity and mortality rates. Health professionals have a responsibility to be aware of and to ensure that the thermoregulatory needs of the infant are upheld in order to provide them with the best start possible. Current medical literature lacks well designed, prospective, randomized controlled trials for both diagnosis and intervention of providing thermoneutral environment and systematic reviews report that none of the interventions have serious adverse effects.
European Resuscitation Council Guidelines for Resuscitation 2005: Section 6. Paediatric life support
2005, Resuscitation

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Reducing heat loss at birth in very preterm infants

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To the Editor:

J Pediatr