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Maintaining Infant Temperature During Delivery Room Resucitation

Question Type:
Intervention
Full Question:
In newborn infants (>30 weeks gestation) during and/or post resuscitation/ stabilization  (P), does drying and skin to skin contact or covering with plastic  (I), compared with drying and no skin to skin or use of radiant warmer or isolette  (C), change body temperature (O)?
Consensus on Science:
Plastic Wraps With or Without Skin Drying and Swaddling Compared With Cot or Crib With or Without Initial Use of Radiant Warmer For the important outcome of normothermia or preventing hypothermia during resuscitation, we could not find any studies reporting on use of plastic bags. During transition (from birth to 1–2 hours after delivery), we identified very-low-quality evidence (downgraded for risk of bias, inconsistency, and imprecision) from 3 randomized clinical trials (Raman 1992, 117; Belsches 2013, e656; Leadford 2013, e128) enrolling 409 newborns of greater than 30 weeks of gestation, showing either a reduction in incidence of hypothermia with plastic after drying (Belsches 2013, e656; Leadford 2013, e128) (RR, 0.77; 95% CI, 0.65–0.90) or no difference in temperature(Raman 1992, 117) with plastic with or without drying compared with cot bed or open crib and swaddling with or without initial use of radiant warmer. Skin-to-Skin Contact Versus Cot or Crib With or Without Use of Radiant Warmer During transition (birth to 1–2 hours after delivery), we identified very-low-quality evidence (downgraded for risk of bias, indirectness, and imprecision) from 7 randomized clinical trials(Fardig 1980, 19; Christensson 1992, 488; Christensson 1996, 1354; Bystrova 2003, 320; Gouchon 2010, 78; Marin Gabriel 2010, 1630; Nimbalkar 2014, 364) enrolling 600 newborns of greater than 30 weeks of gestation showing a reduction in the number of babies with hypothermia when nursed with skin-to-skin contact after delivery(Fardig 1980, 19; Christensson 1996, 1354; Bystrova 2003, 320; Nimbalkar 2014, 364) or similar body temperatures(Christensson 1992, 488; Gouchon 2010, 78; Marin Gabriel 2010, 1630) when compared with cot or crib and swaddling with or without initial use of radiant warmer. Skin-to-Skin Contact Versus Incubator For the important outcome of normothermia or preventing hypothermia during resuscitation, we could not find any studies reporting on skin-to-skin contact. During transition (birth to 1–2 hours after delivery), we identified very-low-quality evidence (downgraded for risk of bias, indirectness, and imprecision) from 2 randomized clinical trials (Christensson 1996, 1354; Bergman 2004, 779) enrolling 66 newborns of greater than 30 weeks of gestation showing reduction in incidence of hypothermia by about 90% (Bergman 2004, 779) or a 50% reduction in drop in body temperature(Christensson 1996, 1354) with skin-to-skin contact compared with incubator.
Treatment Recommendation:
There are no data examining the use of plastic wrap during resuscitation/stabilization. To maintain body temperature or prevent hypothermia during transition (birth to 1–2 hours of life), we suggest that after a well newborn infant of greater than 30 weeks of gestation has been dried, he or she may be put in a clean food-grade plastic bag and swaddled compared with open crib or cot and swaddling. (weak recommendation, very-low-quality evidence) There are no data on skin-to-skin contact during resuscitation/stabilization. To maintain normal body temperature or prevent hypothermia during transition (birth to 1–2 hours after delivery), we suggest well newborns of greater than 30 weeks of gestation be nursed with skin-to-skin contact or kangaroo mother care compared with a cot/open crib and swaddling or incubator (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making this suggestion on plastic wrap, we considered the decrease in hypothermia with plastic. However, clean plastic may not be available and could be costly, and use of unclean plastic may lead to infections. In making this suggestion on skin-to-skin contact, we valued the prevention of hypothermia by using a free and effective intervention. An issue was raised about the quality and the safety of occlusive wrap, and the suggestion was made to include food-grade quality. The question was raised with regard to the availability of thermometers.

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