Total body polyethylene wraps for preventing hypothermia in preterm infants: a randomized trial. Heat Loss Prevention for Preterm Infants in the Delivery Room Plastic Bags for Prevention of Hypothermia in Preterm and Low Birth Weight Infants Reducing hypothermia in preterm infants with polyethylene wrap. Randomized Trial of Plastic Bags to Prevent Term Neonatal Hypothermia in a Resource-Poor Setting Vinyl bags prevent hypothermia at birth in preterm infants Heat Loss Prevention (HeLP) in the delivery room: A randomized controlled trial of polyethylene occlusive skin wrapping in very preterm infants. Effect of polyethylene occlusive skin wrapping on heat loss in very low birth weight infants at delivery: a randomized trial. Polyethylene skin wrapping accelerates recovery from hypothermia in very low-birthweight infants. Thermal management for premature births. Temperature Drop in Normal Term Newborn Infants Born at the University Hospital, Kuala Lumpur Effect of polyethylene bag to prevent heat loss in preterm infants at birth: a randomized controlled trial. Heat loss prevention in very preterm infants in delivery rooms: a prospective, randomized, controlled trial of polyethylene caps. The transparent baby bag. A shield against heat loss. Effect of post‐delivery care on neonatal body temperature Safety and efficacy of vinyl bags in prevention of hypothermia of preterm neonates at birth. Application of Plastic Wrap to Improve Temperatures in Infants Born Less Than 30 Weeks Gestation: A Randomized Controlled Trial
OBJECTIVE To evaluate whether a polyethylene total body wrapping ( covering both the body and head ) is more effective than conventional treatment ( covering up to the shoulders ) in reducing perinatal thermal losses  in very preterm infants . STUDY DESIGN This was a multicenter , prospect i ve , r and omized , parallel 1:1 , unblinded , controlled trial of infants<29 weeks ' gestation age , comprising two study groups : experimental group ( total body group ; both the body and head covered with a polyethylene occlusive bag , with the face uncovered ) and control group ( only the body , up to the shoulders , covered with a polyethylene occlusive bag ) . The primary outcome was axillary temperature on neonatal intensive care unit admission immediately after wrap removal . RESULTS One hundred r and omly allocated infants ( 50 in the total body group and 50 controls ) completed the study .  Mean axillary temperature on neonatal intensive care unit admission was similar in the two groups ( 36.5±0.6 ° C total body vs 36.4±0.8 ° C controls ; P=.53 ) . The rate of moderate hypothermia ( temperature<36 ° C ) was 12 % in the total body group and 20 % in the control group ( P=.41 ) . Three subjects in each group ( 6.0 % ) had an axillary temperature>37.5 ° C on admission , and one subject in control group had an axillary temperature>38 ° C . CONCLUSION Total body wrapping is comparable with covering the body up to the shoulders in preventing postnatal thermal losses in very preterm infants OBJECTIVE : Preterm infants are prone to hypothermia immediately following birth . Among other factors , excessive evaporative heat loss and the relatively cool ambient temperature of the delivery room may be important contributors . Most infants < 29 weeks gestation had temperatures < 36.4 ° C on admission to our neonatal unit ( NICU ) . Therefore we conducted a r and omized , controlled trial to evaluate the effect of placing these infants in polyurethane bags in the delivery room to prevent heat loss and reduce the occurrence of hypothermia on admission to the NICU . METHODS : After parental consent was obtained , infants expected to be < 29 weeks gestation were r and omized to intervention or control groups just prior to their birth . Infants r and omized to the intervention group were placed in polyurethane bags up to their necks immediately after delivery before being dried . They were then resuscitated per NRP guidelines , covered with warm blankets , and transported to the NICU , where the bags were removed and rectal temperatures were recorded . Control infants were resuscitated , covered with warm blankets , and transported without being placed in polyurethane bags . Delivery room temperatures were recorded so this potentially confounding variable could be assessed . RESULTS : Intervention patients were less likely than control patients to have temperature < 36.4 ° C on admission , 44 vs 70 % ( p<0.01 ) and the intervention group had a higher mean admission temperature , 36.5 ° C vs 36.0 ° C ( p<0.003 ) . This effect remained significant ( p<0.0001 ) when delivery room temperature was controlled in analysis . Warmer delivery room temperatures ( ≥26 ° C ) were associated with higher admission temperatures in both intervention and control infants , but only the subgroup of intervention patients born in warmer delivery rooms had a mean admission temperature > 36.4 ° C . CONCLUSIONS : Placing infants < 29 weeks gestation in polyurethane bags in the delivery room reduced the occurrence of hypothermia and increased their NICU admission temperatures . Maintaining warmer delivery rooms helped but was insufficient in preventing hypothermia in most of these vulnerable patients without the adjunctive use of the polyurethane bags BACKGROUND AND OBJECTIVES : Hypothermia contributes to neonatal mortality and morbidity , especially in preterm and low birth weight infants in developing countries . Plastic bags covering the trunk and extremities of very low birth weight infants reduces hypothermia . This technique has not been studied in larger infants or in many re source -limited setting s. The objective was to determine if placing preterm and low birth weight infants inside a plastic bag at birth maintains normothermia . METHODS : Infants at 26 to 36 weeks ’ gestational age and /or with a birth weight of 1000 to 2500 g born at the University Teaching Hospital in Lusaka , Zambia , were r and omized by using a 1:1 allocation and parallel design to st and ard thermoregulation ( blanket or radiant warmer ) care or to st and ard thermoregulation care plus placement inside a plastic bag at birth . The primary outcome measure was axillary temperature in the World Health Organization – defined normal range ( 36.5–37.5 ° C ) at 1 hour after birth . RESULTS : A total of 104 infants were r and omized . At 1 hour after birth , infants r and omized to plastic bag ( n = 49 ) were more likely to have a temperature in the normal range as compared with infants in the st and ard thermoregulation care group ( n = 55 ; 59.2 % vs 32.7 % ; relative risk 1.81 ; 95 % confidence interval 1.16–2.81 ; P = .007 ) . The temperature at 1 hour after birth in the infants r and omized to plastic bag was 36.5 ± 0.5 ° C compared with 36.1 ± 0.6 ° C in st and ard care infants ( P < .001 ) . Hyperthermia ( > 38.0 ° C ) did not occur in any infant . CONCLUSIONS : Placement of preterm/low birth weight infants inside a plastic bag at birth compared with st and ard thermoregulation care reduced hypothermia without result ing in hyperthermia , and is a low-cost , low-technology tool for re source -limited setting BACKGROUND Occlusive plastic applied immediately after birth to reduce evaporative heat loss has been proven effective in preterm infants < 28 weeks ' gestation . However its effectiveness on preterm infants > 28 weeks ' gestation has not been shown . This study aim ed to determine the effect of occlusive wrap at birth on the temperature at neonatal intensive care unit ( NICU ) admission among infants of greater than or equal to 24 weeks ' and less than 34 weeks ' gestation . METHODS Study infants were r and omly assigned to " wrap " or " control " groups . Newborns in the wrap group were wrapped with polyethylene plastic sheets within the first min after birth . Infants r and omized to the control group were dried immediately after birth with warmed towels under a warmer , according to the guidelines of Neonatal Resuscitation . Infants ' axillary temperatures were measured on admission to the NICU , and after having been stabilized in incubators in the NICU . RESULTS A total of 110 infants were recruited into the study . The mean admission temperature was significantly higher in the wrap group ( 35.8 vs 34.8 ° C , P < 0.01 ) . Admission hypothermia ( axillary temperature < 36.5 ° C ) was present in 38 ( 78 % ) and 58 ( 98 % ) infants in the wrap and control groups , respectively . Among infants of < 28 weeks ' gestation , the post-stabilization temperature was significantly higher in the wrap group . CONCLUSIONS Wrapping premature infants with gestational age < 34 weeks in polyethylene plastics immediately after birth is associated with lower incidence of hypothermia OBJECTIVES : Term infants in re source -poor setting s frequently develop hypothermia during the first hours after birth . Plastic bags or wraps are a low-cost intervention for the prevention of hypothermia in preterm and low birth weight infants that may also be effective in term infants . Our objective was to test the hypothesis that placement of term neonates in plastic bags at birth reduces hypothermia at 1 hour after birth in a re source -poor hospital . METHODS : This parallel-group r and omized controlled trial was conducted at University Teaching Hospital , the tertiary referral center in Zambia . Inborn neonates with both a gestational age ≥37 weeks and a birth weight ≥2500 g were r and omized 1:1 to either a st and ard thermoregulation protocol or to a st and ard thermoregulation protocol with placement of the torso and lower extremities inside a plastic bag within 10 minutes after birth . The primary outcome was hypothermia ( < 36.5 ° C axillary temperature ) at 1 hour after birth . RESULTS : Neonates r and omized to plastic bag ( n = 135 ) or to st and ard thermoregulation care ( n = 136 ) had similar baseline characteristics ( birth weight , gestational age , gender , and baseline temperature ) . Neonates in the plastic bag group had a lower rate of hypothermia ( 60 % vs 73 % , risk ratio 0.76 , confidence interval 0.60–0.96 , P = .026 ) and a higher axillary temperature ( 36.4 ± 0.5 ° C vs 36.2 ± 0.7 ° C , P < .001 ) at 1 hour after birth compared with infants receiving st and ard care . CONCLUSIONS : Placement in a plastic bag at birth reduced the incidence of hypothermia at 1 hour after birth in term neonates born in a re source -poor setting , but most neonates remained hypothermic Objective To compare the effect of st and ard care vs. the use of vinyl bags ( Vi-Drape ® isolation bag ) on admission temperature in extremely premature infants ≤28 weeks gestational age at birth . Methods Twenty seven premature infants with similar baseline characteristics were assigned and placed in vinyl bags ( n=14 ) immediately following delivery without drying or received st and ard care ( controls , n=13 ) , including drying and placement under a radiant warmer .  Axillary temperature was recorded on admission to the neonatal unit . Results The average temperature in the vinyl bag group was significantly higher ( 35.9 ± 0.13 vs 34.9 ± 0.24 ° C , p = 0.002 ) . Although the cord blood pH was similar between the two groups ( 7.33 + 0.02 in the vinyl bag group and 7.33 ± 0.01 in the control group ) , the worst pH in the first 6 hours of life was significantly lower in the control group ( 7.32 ± 0.02 vs 7.22 ± 0.04 , p = 0.03 ) . There was a significant increase in maximal oxygen requirement during the first 24h in the control group ( 82.9 vs 43.3 % in the vinyl bag group , p = 0.0004 ) . Conclusion Vinyl bags  prevent heat loss and are a simple and effective intervention in preventing hypothermia in the delivery room and early acidosis in premature infants OBJECTIVES 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 . STUDY DESIGN This was a r and omized 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 . RESULTS Of 55 infants r and omly 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 . CONCLUSIONS Polyethylene occlusive skin wrapping prevents rather than delays heat loss at delivery in very preterm infants OBJECTIVE Significant evaporative heat loss in the very low birth weight infant can occur in the delivery room . We investigated the effect of polyethylene wrap applied immediately at birth ( without drying ) on rectal temperature measured at nursery admission . STUDY DESIGN Sixty-two consecutive infants delivered at < 32 weeks ' gestation were stratified by gestational age and r and omly allocated to resuscitation with polyethylene wrap . All infants were resuscitated under radiant warmers . Wraps were removed on nursery admission . Rectal temperature was taken by digital electronic thermometer . RESULTS Fifty-nine of 62 recruited infants completed the study .  Maternal temperature , delivery room temperature , transfer-incubator temperature , and time to admission were recorded . Use of occlusive wrapping result ed in a significantly higher admission rectal temperature in infants < 28 weeks ' gestation ( difference in means = 1.9 C , P < .001 ) . No significant difference was seen in admission rectal temperature in infants of 28 to 31 weeks ' gestation ( difference in means = 0.17 C , P = .47 ) . All 5 deaths were in the nonwrap group ( vs wrap , P = .04 ) ; their mean temperature was 35.1 C versus 36.5 C in survivors ( P = .001 ) . CONCLUSIONS Occlusive wrapping of very low birth weight infants at delivery reduces postnatal temperature fall . This may result in a decreased mortality rate BACKGROUND Thermal management of the very low-birthweight ( VLBW ) infant is a cornerstone of neonatology because thermal stress is an important determinant of survival . This prospect i ve study was design ed to determine the effects of polyethylene occlusive skin wrapping on heat loss in VLBW infants admitted to the neonatal intensive care unit ( NICU ) promptly after birth . METHODS Thirty consecutively inborn infants weighing < 1500 g were allocated to a wrap or non-wrap group within an incubator  after admission to the NICU .  Axillary and incubator temperatures were taken on arrival at 1 and 2 h. RESULTS Infants in the wrap group reached a normal axillary temperature faster then non-wrap infants and required lower incubator temperatures . CONCLUSIONS Polyethylene film wrapping effectively helps to correct hypothermia in VLBW infants admitted to the NICU AIM This paper reports an audit of the effect on admission temperatures of using occlusive polyethylene wrap applied immediately after the birth of extremely premature infants . BACKGROUND Use of occlusive polyethylene wrap during the early postnatal management of the premature infant reduces evaporative and convective heat loss . METHOD Retrospective pre-intervention audit was carried out , followed by the introduction of occlusive polyethylene wrap for thermal management during resuscitation and early stabilization . Prospect i ve post-intervention audit was then performed . The pre-intervention ( control ) group infants were immediately dried with prewarmed towels and resuscitated under radiant heat . Infants in the intervention group were managed under radiant heat , were not dried but were immediately enclosed in an occlusive polyethylene wrap . RESULTS The demographic characteristics of the two groups were comparable . Use of occlusive polyethylene wrap result ed in higher admission temperatures for infants less than 27 weeks gestation ( z=108.50 , P<0.01 ) . There was no statistically significant improvement in admission temperatures for 27 - 29 week infants . The rate of hypothermia on admission ( < 35.6 degrees C per axilla ) was lower in the intervention group ( chi(2)=5.12 , d.f.=1 , P=0.02 ) , but more infants recorded temperatures exceeding 37.2 degrees C during the first 12 hours ( chi(2)=23.45 , d.f.=1 , P<0.01 ) . There were no other adverse effects noted . CONCLUSION Use of occlusive polyethylene wrap improved admission temperatures for infants less than 27 weeks gestation . This intervention is easy to implement and does not interfere with resuscitation . However , removal of the wrap should be considered following admission to a closed care system in the neonatal intensive care unit because , in the intervention group , hyperthermia in the first 12 hours was a potential side effect EDITORIAL COMMENT : This paper was accepted for publication to remind readers that newborn infants , especially if premature , should promptly be dried , wrapped and placed in a cot . It is recommended that at about 1 hour of age , if the temperature is normal ( ≥ 36.5 oC per axilla , 36.8oC per rectum ) and stable , the baby is undressed for measurement , estimation of birth‐weight and the routine examination . Our paediatrician review er commented that many obstetricians may have forgotten the importance of prevention of cooling of the newborn infant , the care of whom is usually left to members of the nursing staff . We all agree that bonding between mother and baby is important but should not delay the baby being dried and covered promptly after birth BACKGROUND Hypothermia at birth has been associated with increased morbidity and mortality in preterm infants . OBJECTIVE To evaluate the effect of wrap with polyethylene bag at birth on admission temperatures and the incidences of hypothermia on admission in preterm infants gestational age < or = 32 weeks . MATERIAL AND METHOD A r and omized controlled trial was conducted in thirty-eight preterm infants with gestational age < or = 32 weeks . The infants were assigned and placed in polyethylene bag immediately after birth without drying under a radiant warmer or received st and ard thermal care including being dried and placed under a radiant warmer .  Rectal temperatures were recorded on admission to neonatal unit and incidences o hypothermia were compared between the two groups . RESULTS The body temperatures of preterm infants with polyethylene bag were significantly higher than those of the control group { median 36.5 degrees C ( range 35.5 degrees C-37.2 degrees C ) vs. 35.9 degrees C ( range 34.9 degrees C-36.5 degrees C ) , p < 0.001}. On admission , the incidence of hypothermia in preterm infants wrap with polyethylene bag was significantly lower than in the control group ( 26 % vs. 89 % , p < 0.001 ) with a risk reduction of 0.63 ( 95 % CI 0.39 - 0.87 ) and a number needed to treat of 1.58 . CONCLUSION Polyethylene bag prevents heat loss at delivery in preterm infant less than 32 weeks gestation . Incidence of hypothermia was significantly reduced by use of polyethylene bag , a simple and inexpensive intervention OBJECTIVE To evaluate in preterm infants whether polyethylene caps prevent heat loss after delivery better than polyethylene occlusive wrapping and conventional drying . STUDY DESIGN This was a prospect i ve , r and omized , controlled trial of infants < 29 weeks ' gestation including 3 study groups : ( 1 ) experimental group in which the heads of patients were covered with a polyethylene cap ; ( 2 ) polyethylene occlusive skin wrap group ; and ( 3 ) control group in which infants were dried .  Axillary temperatures were compared at the time of admission to the neonatal intensive care unit ( NICU ) immediately after cap and wrap removal and 1 hour later . RESULTS The 96 infants r and omly assigned ( 32 covered with caps , 32 wrapped , 32 control ) completed the study .  Mean axillary temperature on NICU admission was similar in the cap group ( 36.1 degrees C + /- 0.8 degrees C ) and wrap group ( 35.8 degrees C + /- 0.9 degrees C ) , and temperatures on admission to the NICU were significantly higher than in the control group ( 35.3 degrees C + /- 0.8 degrees C ; P < .01 ) . Infants covered with polyethylene caps ( 43 % ) and placed in polyethylene bags ( 62 % ) were less likely to have a temperature < 36.4 degrees C on admission to the NICU than control infants ( 90 % ) . In the cap group , temperature 1 hour after admission was significantly higher than in the control group . CONCLUSIONS For very preterm infants , polyethylene caps are comparable with polyethylene occlusive skin wrapping to prevent heat loss after delivery . Both these methods are more effective than conventional treatment Abstract Swaddling of newborn infants in double-layered , clear-plastic bags with a head shield allowed less heat loss than a radiant heater alone . Protection against heat loss is increased if the plastic bag is combined with a radiant heater . This protection is accomplished without severe compromise of either visualization or h and ling of the infant A prospect i ve observational study of post‐delivery care and neonatal body temperature , carried out at Kathm and u Maternity Hospital , was followed by a r and omized controlled intervention study using three simple methods for maintaining body temperature . There were 500 infants in the initial observation study and 300 in the intervention study . In the observation study , 85 % ( 420/495 ) of infants had temperatures < 36 ° C at 2 h and nearly 50 % ( 198/405 ) had temperatures < 36 ° C at 24 h ( 14 % were < 35 ° C ) . Most of the infants who were cold at 24 h had initially become cold at the time of delivery ( only seven infants had been both well dried and wrapped ) . In the intervention study , all infants were dried and wrapped before r and om assignment to one of the three methods : the “ kangaroo ” method , the traditional “ oil massage ” or a “ plastic swaddler ” . All three were found to be equally effective . Overall , 38 % ( 114/298 ) of the infants had temperatures < 36 ° C at 2 h and 18 % ( 41/231 ) at 24 h ( when none was < 35 ° C ) The present study was planned to evaluate the safety and efficacy of vinyl bags in prevention of hypothermia during resuscitation at birth in very low birth weight neonates . Sixty neonates of gestational age ≤32 weeks and birth weight ≤ 1500gm were r and omised to either study group , or control group . Study group neonates were put in vinyl bags up to neck and the head was covered with a cap after drying immediately following delivery and resuscitated under radiant warmer . Control group neonates were resuscitated by conventional drying under radiant warmer . Mean axillary and rectal temperature recorded immediately after admission to NICU were significantly higher in the study group compared to control group . Temperature recorded after 1 hour of admission to NICU were however comparable between the two groups . As temperature maintenance in these VLBW neonates is of tremendous importance , it would make sense to recommend the use of vinyl bags during their resuscitation Purpose : The primary aim of the study was to evaluate whether the application of a plastic wrap immediately after birth is more effective than the st and ard care of temperature management for improving admission temperatures to the neonatal intensive care unit ( NICU ) in infants < 30 weeks gestation . Design : A r and omized controlled trial was conducted . Infants in the intervention group were transferred to a prewarmed radiant heater immediately after birth and encased in NeoWrap from the neck down without being dried . The infant ’s head was dried with a prewarmed towel and a hat added . The control group received usual care for the unit ; the infant was transferred to the prewarmed radiant warmer and dried , and warm towels and a hat are then applied . Sample : A total of 92 infants were analyzed : 49 in the control group and 43 in the intervention group ; 48 ( 52.2 percent ) were < 27 weeks gestation , and 44 ( 47.8 percent ) were < 30 weeks gestation . The infants ’ temperatures were assessed for two hours following admission . Main Outcome Variable : The application of a plastic wrap and hat significantly increased NICU admission temperature in infants < 30 weeks gestation . Results : Of the 92 infants , 43 ( 51.2 percent < 27 weeks and 48.8 percent < 30 weeks ) were r and omized to the experimental group and 49 ( 53.1 percent < 27 weeks and 46.9 percent < 30 weeks ) to the control group . The mean first temperature was 36.15 ° C ( SD = 0.85 ) for intervention and 35.81 ° C ( SD = 0.91 ) for control infants ( p=.074 ) ; whereas the respective admission temperatures were 36.26 ° C ( SD = 0.68 ; n = 42 ) and 35.79 ° C ( SD = 0.77 ; n = 44 ; p=.004 ) . The mean temperature of the infants rose steadily from the time of birth to two hours follow-up in both the intervention ( 36.15 ° –37.03 ° C ; SD = 0.49 ; n = 40 ) and control groups ( 35.81 ° –36.75 ° C ; SD = 0.70 ; n = 47 ; p<.001 , respectively )
Neonatal hypothermia is an important risk factor for mortality and morbidity , and is common even in temperate climates .
We conducted a systematic review to determine whether plastic coverings , used immediately following delivery , were effective in reducing the incidence of mortality , hypothermia and morbidity .