Consequences of Hypothermia

Laptook AR Salhab W, Bhaskar B, et al. Admission Temperature of Low Birth Weight Infants: Predictors and Associated Morbidities. PEDIATRICS (March 2007); 119: E643-E649. [Full text] [PDF]

BACKGROUND. There is a paucity of information on the maintenanceof body temperature at birth for low birth weight infants.

OBJECTIVES. We examined the distribution of temperatures inlow birth weight infants on admission to the NICUs in the NeonatalResearch Network centers and determined whether admission temperaturewas associated with antepartum and birth variables and selectedmorbidities and mortality.

METHODS. Infants without major congenital anomalies born during2002 and 2003 with birth weights of 401 to 1499 g who were admitteddirectly from the delivery room to the NICU were included. Bivariateassociations between antepartum/birth variables and admissiontemperature and selected morbidities/mortality and admissiontemperature were examined, followed by multivariable linearor logistic regressions to detect independent associations.

RESULTS. There were 5277 study infants and the mean (±SD)birth weight and gestational age were 1036 ± 286 g and28 ± 3 weeks, respectively. The distribution of admissiontemperatures was 14.3% at <35°C, 32.6% between 35 and35.9°C, 42.3% between 36 and 36.9°C, and 10.8% at

37°C.The estimate of birth weight on admission temperature with and without intubation was +0.13°C and +0.04°C per 100-gincrease in birth weight, respectively. The mean admission temperaturefor each center varied from 1.5°C below to 0.3°C abovea reference center. On adjusted analyses, admission temperaturewas inversely related to mortality (28% increase per 1°Cdecrease) and late-onset sepsis (11% increase per 1°C decrease)but not to intraventricular hemorrhage, necrotizing enterocolitis,or duration of conventional ventilation.

CONCLUSIONS. Preventing decreases in temperature at birth amonglow birth weight infants remains a challenge. Associations withintubation and center of birth suggest that assessment of temperaturecontrol for infants intubated in the delivery room may be beneficial.Whether the admission temperature is part of the casual pathor a marker of mortality needs additional study.

Comments: In this observational cohort study, keeping very low birth weight babies warmer after delivery was clearly associated with improved survival and fewer infections. There is considerable variation between centers on how well we accomplish this. The use of polyethylene wraps or polyurethanebags has been shown to be more effective than drying for preventing hypothermia in this population. See 6-003 for a review of the Heat Loss Prevention (HeLP) Trial. ABK.

1- can you please give a practical guideline for time of using and removing the plastic bag
2- address of the company from it we can get the plastic bags

UserName: FAWZYA AREF
Institution: maternity and children hospital - Jeddah
telephone:
email: fwzarif@yahoo.com

For infants in the wrap group, a polyethylene bag was opened under the radiant warmer, the infant was placed on the bag from the shoulders down, and the entire body was wrapped.4 Only the head was dried. The polyethylene bags measured 20 cm by 50 cm and were manufactured by Eastern Paper, a Division of EPC Industries Ltd. Oxygenation, bag-mask ventilation, endotracheal intubation, and chest compressions were initiated in the delivery room as appropriate; more extensive stabilization including vascular access was performed in the NICU, which was immediately adjacent to the delivery room suite. All infants were carried by one member of the neonatal team from the delivery room into the NICU and placed in a single walled incubator with 60% humidity (Ohmeda/Ohio Medical Care Plus). At this point, the wrap was removed in the experimental group.

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