Thermal Care Interventions Result in Reduced Neonatal Hypothermia Risk

Thangaraj Abiramalatha, DM

New research shows the majority of thermal care interventions do result in a reduced core body temperature and reduced risk of hypothermia for preterm neonatal offspring.

A team, led by Thangaraj Abiramalatha, DM, Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, identified the optimal delivery room thermal care intervention that reduces neonatal hypothermia and improves clinical outcomes for preterm neonates born at 36 weeks’ gestation or less.

The researchers searched several common databases from inception to November 5, 2020, to identify randomized and quasi-randomized clinical trials of thermal care interventions in the delivery room for preterm neonates, as well as peer-reviewed abstracts and studied published in non-English languages. Overall, they identified and screened 6154 titles and abstracts and analyzed 34 studies involving

The investigators extracted data from the identified trials in duplicate using a structured proforma and used a network meta-analysis with Bayesian random-effects model for data synthesis.

The investigators sought primary outcomes of core body temperature and incidence of moderate to severe hypothermia on admission or within the first 2 hours of life. They also sought secondary outcomes of incidence of hyperthermia, major brain injury, and mortality prior to discharge.

Thermal Care Interventions

The research team evaluated 9 thermal interventions, including plastic bag or plastic wrap covering the torso and limbs with the head uncovered or covered with a cloth cap, plastic cap covering the head, skin-to-skin contact thermal mattress, plastic bag or plastic wrap with a plastic cap, plastic bag or plastic wrap along with use of a thermal mattress, plastic bag or plastic wrap along with heated humidified gas for resuscitation or for initiating respiratory support in the delivery room, plastic bag or plastic wrap along with an incubator for transporting from the delivery room, and routine care, including drying and covering the body with warm blankets, with or without a cloth cap.

Plastic bag or wrap with a thermal mattress (mean difference, 0.98 °C; 95% CrI, 0.60-1.36 °C), plastic cap (MD, 0.83 °C; 95% CrI, 0.28-1.38 °C), plastic bag or wrap with heated humidified respiratory gas (MD, 0.76 °C; 95% CrI, 0.38-1.15 °C), plastic bag or wrap with a plastic cap (MD, 0.62 °C; 95% CrI, 0.37-0.88 °C), thermal mattress (MD, 0.62 °C; 95% CrI, 0.33-0.93 °C), and plastic bag or wrap (MD, 0.56 °C; 95% CrI, 0.44-0.69 °C) were all associated with greater core body temperature when compared to routine care.

Differences in Effectiveness

However, the certainty of evidence was moderate for 5 of the interventions, but low for plastic bag or wrap with a thermal mattress.

Plastic bag or wraps with heated humidified respiratory gas was also linked to a decrease risk of major brain injuries (RR, 0.23; 95% CrI, 0.03-0.67; moderate certainty of evidence) when compared to routine care alone, while a plastic bag or wrap with a plastic cap was associated with a reduced risk of mortality (RR, 0.19; 95% CrI, 0.02-0.66; low certainty of evidence).

“Results of this study indicate that most thermal care interventions in the delivery room for preterm neonates were associated with improved core body temperature (with moderate certainty of evidence),” the authors wrote. “Specifically, use of a plastic bag or wrap with a plastic cap or with heated humidified gas was associated with lower risk of major brain injury and mortality (with low to moderate certainty of evidence).”

The study, “Delivery Room Interventions for Hypothermia in Preterm Neonates,” was published online in JAMA Pediatrics.