HEat Loss Prevention (HELP) in the delivery room: a randomized clinical trial (RCT) in very preterm infants

Department of Pediatrics, McMaster University, the Children's Hospital of Hamilton Health Sciences, Hamilton, Ontario, Canada.
Journal of Pediatrics (Impact Factor: 3.79). 01/2005; 145(6):750-3. DOI: 10.1016/j.jpeds.2004.07.036
Source: PubMed


To determine if polyethylene occlusive skin wrapping of very preterm infants prevents heat loss after delivery better than conventional drying and to evaluate if any benefit is sustained after wrap removal.
This was a randomized controlled trial of infants <28 weeks' gestation. The experimental group was wrapped from the neck down. Only the head was dried. Control infants were dried completely. Rectal temperatures were compared on admission to the neonatal intensive care unit immediately after wrap removal and 1 hour later.
Of 55 infants randomly assigned (28 wrap, 27 control), 2 died in the delivery room and 53 completed the study. Wrapped infants had a higher mean rectal admission temperature, 36.5 degrees C (SD, 0.8 degrees C), compared with 35.6 degrees C (SD, 1.3 degrees C) in control infants ( P = .002). One hour later, mean rectal temperatures were similar in both groups (36.6 degrees C, SD, 0.7 degrees C vs 36.4 degrees C, SD, 0.9 degrees C, P = .4). Size at birth was an important determinant of heat loss: Mean rectal admission temperature increased by 0.21 degrees C (95% CI, 0.04 to 0.4) with each 100-g increase in birth weight.
Polyethylene occlusive skin wrapping prevents rather than delays heat loss at delivery in very preterm infants.

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    • "During the immediate postnatal stabilization and resuscitation , full access to the infant is required, rendering care in a closed incubator impossible. In this situation , hypothermia is best avoided by placing the infant in a polyethylene bag under a radiant heater [7] [8]. The plastic bag reduces evaporative heat loss by creating a microenvironment with a high relative humidity, while it allows radiative heat transfer to the infant. "
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    ABSTRACT: Newborn preterm infants have large losses of fluid from their immature skin. To minimize fluid and heat loss and reduce the risk of dehydration and hypothermia, infants are routinely nursed in humidified and temperature-controlled incubators. The incubator care can be interrupted by periods of skin-to-skin care (STS). However, data are limited on how to reduce fluid and heat loss from very preterm infants during STS. To investigate the effect of clothing during STS we measured the evaporation of water from the surface of a body/skin model designed to simulate the skin temperature and ambient conditions of an extremely preterm infant during the first days of life. A semi-permeable membrane was placed on top of a water filled chamber heated to body temperature and kept in an incubator at relevant environmental conditions. The evaporation rate (ER) was determined by evaporimetry from the membrane surface alone or from the membrane covered with layers of fabric. The effect of fabric clothing was also determined in a group of extremely preterm infants during incubator care. The evaporation rate (ER) was 51 ± 2.7 g/m 2 h from the membrane only. When layers of fabric were applied, ER decreased for each added layer. The ER and temperatures recorded in the model system were in the range relevant for preterm infants. In the infants, fabric clothing also resulted in a decreased ER. We conclude that layers of a simple cotton fabric provide a significant barrier to vapor diffusion thereby reducing evaporative loss of water and heat.
    Full-text · Article · Jan 2011
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    • "With regards to measures for thermal control, significant differences were found between the protocols in German speaking countries and the 2005 ILCOR recommendations: only 63% of responding units used polyethylen wrappings but 81% used head covers. Taking into account that these procedures require only inexpensive equipment and little time, and despite good evidence and clear ILCOR recommendations towards their use, it is not clear why these measures were not universally employed [1,23,30]. However conversely, although no clear-cut recommendations on late cord clamping were given for preterm neonates in the 2005 ILCOR guidelines, according to our survey 44% of units already advise to perform late cord clamping (> 30 sec), much in line with evidence from a recent meta-analysis [15]. "
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    ABSTRACT: Surveys from the USA, Australia and Spain have shown significant inter-institutional variation in delivery room (DR) management of very low birth weight infants (VLBWI, <1500g) at birth, despite regularly updated international guidelines. To investigate protocols for DR management of VLBWI in Germany, Austria and Switzerland and to compare these with the 2005 ILCOR guidelines. DR management protocols were surveyed in a prospective, questionnaire-based survey in 2008. Results were compared between countries and between academic and non-academic units. Protocols were compared to the 2005 ILCOR guidelines. In total, 190/249 units (76%) replied. Protocols for DR management existed in 94% of units. Statistically significant differences between countries were found regarding provision of 24 hr in house neonatal service; presence of a designated resuscitation area; devices for respiratory support; use of pressure-controlled manual ventilation devices; volume control by respirator; and dosage of Surfactant. There were no statistically significant differences regarding application and monitoring of supplementary oxygen, or targeted saturation levels, or for the use of sustained inflations. Comparison of academic and non-academic hospitals showed no significant differences, apart from the targeted saturation levels (SpO2) at 10 min. of life. Comparison with ILCOR guidelines showed good adherence to the 2005 recommendations. Delivery room management in German, Austrian and Swiss neonatal units was commonly based on written protocols. Only minor differences were found regarding the DR setup, devices used and the targeted ranges for SpO2 and FiO2. DR management was in good accordance with 2005 ILCOR guidelines, some units already incorporated evidence beyond the ILCOR statement into their routine practice.
    Full-text · Article · Nov 2010 · European journal of medical research
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