Temperature Control of Premature Infants in the Delivery Room

The effect of massage therapy alone or together with passive mobilisations on weight gain and length of hospitalisation in very preterm and moderate-to-late preterm infants remains to be elucidated.

To compare massage therapy alone or combined with passive mobilisations with a control group in preterm infants.

A systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was conducted. Randomised controlled trials comparing massage therapy alone or combined with passive mobilisations with a control group in preterm infants were included. MEDLINE, EMBASE, ENFISPO, PEDro and Cochrane databases were searched up to March 2022.

Preterm infants.

Weight gain and time of hospitalisation.

Compared to usual care, massage therapy combined with passive mobilisations was demonstrated to be more effective in improving weight gain (standardized mean difference [95%CI] 0.67 [0.31, 1.02]) and reducing length of hospitalisation (0.53 [0.10, 0.97]) outcomes. However, massage therapy alone was not effective in improving weight gain (1.14 [−0.22, 2.49]). No differences in the effectiveness of these therapies between groups according to gestational age were found (p > 0.05).

Based on fair-to-high quality evidence, massage therapy combined with passive mobilisations significantly improves weight gain and reduces length of hospitalisation in premature infants. However, massage therapy alone does not achieve these improvements.

A high incidence of postnatal hypothermia has been reported in high-as well low-resource countries and it remains an independent predictor of neonatal morbidity and mortality, especially in very preterm infants in all settings. The temperature of newly born infants should be maintained between 36.5 and 37.5 °C after birth through admission and stabilization. Interventions to achieve this may include environmental temperature 23–25 °C, use of radiant warmers, exothermic mattresses, woollen or plastic caps, plastic wraps, humidified and heated gases. Skin-to-skin contact has been used, especially in low-resource settings. The combinations of these interventions applied to quality improvement initiatives, including staff training, use of checklists, and continuous feedback with the staff involved in the management of the neonate, are key factors to prevent heat loss from delivery room to admission to the neonatal intensive care unit. The admission temperature should be recorded as a predictor of outcomes as well as a quality indicator.

Successful transition from the intrauterine to extrauterine environment is dependent on several significant physiologic changes that must occur within minutes of birth. Most infants effectively transition at delivery without requiring any special assistance. However, about 10% of infants will require some level of intervention, and 1% will require extensive resuscitative measures at birth. The focus of this article is on the preparation for and management of an unexpected delivery in the emergency department. We will highlight the unique aspects of newborn resuscitation, as well as recent changes to the Neonatal Resuscitation Program from the 2015 American Heart Association Guidelines.

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.

This was a multicenter, prospective, randomized, 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.

One hundred randomly 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.

Total body wrapping is comparable with covering the body up to the shoulders in preventing postnatal thermal losses in very preterm infants.

For more than a century, nurses and physicians have recognized the importance of maintaining the temperature of newborn infants, especially for premature and low birth weight infants. Research has confirmed and elucidated how infants lose heat and what is required to keep them warm. Adverse outcomes associated with hypothermia have been carefully documented. Variations in practice exist and fail to optimize infant outcomes. In this context, the Collaboration for Advancing Pediatric Quality Measures (CAPQuaM) was assigned the task of developing quality measures related to hypothermia and low birth weight infants. This paper integrates a literature review with the CAPQuaM measure development process, and includes original data (qualitative interviews). The authors call for the use of new CAPQuaM measures both to enhance accountability and to improve outcomes for these vulnerable low birth weight infants.