Randomized Trial of Occlusive Wrap for Heat Loss Prevention in Preterm Infants

Reilly, Maureen; Vohra, Sunita; Rac, Valeria E.; Dunn, Michael; Ferrelli, Karla; Kiss, Alex; Vincer, Michael; Wimmer, John; Zayack, Denise; Soll, Roger F.

doi:10.1016/j.jpeds.2014.09.068

Cited by 81 publications

(76 citation statements)

References 23 publications

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“…Preterm infants are especially vulnerable. Hypothermia is also associated with serious morbidities, such as increased risk of IVH, 19,26,39,[50][51][52][53][54] respiratory issues, 15,19,21,50,[55][56][57][58][59][60] hypoglycemia, 15,44,[60][61][62][63][64] and late-onset sepsis. 33,65 Because of this, admission temperature should be recorded as a predictor of outcomes as well as a quality indicator (Class I, LOE B-NR.)…”

Section: Importance Of Maintaining Normal Temperature In the Deliverymentioning

confidence: 99%

Part 13: Neonatal Resuscitation

Wyckoff¹,

Aziz²,

Escobedo³

et al. 2015

Circulation

615

344

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Section: Importance Of Maintaining Normal Temperature In the Deliverymentioning

confidence: 99%

Part 13: Neonatal Resuscitation

Wyckoff¹,

Aziz²,

Escobedo³

et al. 2015

Circulation

615

344

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“…There is evidence of a dose effect on mortality, suggesting an increased risk of at least 28% for each 1°b elow 36.5°C body temperature at admission 42,43 and dose-dependent effect size. 42,43,48,66 One small randomized clinical trial 78 (very-low-quality evidence, downgraded for indirectness and serious imprecision) showed a reduction in adverse events, including death, intracranial hemorrhage, necrotizing enterocolitis, and oxygen dependence with improved temperature management, but 3 randomized controlled trials [79][80][81] (low-quality evidence, downgraded for indirectness and imprecision) did not show any significant improvement in mortality with significantly improved temperature control. Four observational studies 60,61,63,82 (very-low-quality evidence, downgraded for indirectness and imprecision) did not find any improvement in mortality with improved admission temperatures, but they were not sufficiently powered for this outcome.…”

Section: Consensus On Sciencementioning

confidence: 99%

“…43,60,61,[88][89][90][91][92] For the important outcome of respiratory issues, there is evidence from 9 observational studies 44,48,50,67,83,[93][94][95][96] (low-quality evidence) showing an association between hypothermia and respiratory disease. One large randomized controlled trial 79 (low-quality evidence, downgraded for imprecision and risk of bias) found a reduction in pulmonary hemorrhage associated with improved admission temperature (OR, 0.57; 95% CI, 0.35-0.94). Eight observational studies (very-low-quality evidence) have shown an improvement in respiratory outcomes after improved admission temperature maintenance.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 7: Neonatal Resuscitation

Perlman¹,

Wyllie²,

Kattwinkel³

et al. 2015

Pediatrics

237

291

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“…There is evidence of a dose effect on mortality, suggesting an increased risk of at least 28% for each 1° below 36.5°C body temperature at admission 42,43 and dose-dependent effect size. 42,43,48,66 One small randomized clinical trial 78 (very-lowquality evidence, downgraded for indirectness and serious imprecision) showed a reduction in adverse events, including death, intracranial hemorrhage, necrotizing enterocolitis, and oxygen dependence with improved temperature management, but 3 randomized controlled trials [79][80][81] (low-quality evidence, downgraded for indirectness and imprecision) did not show any significant improvement in mortality with significantly improved temperature control. Four observational studies 60,61,63,82 (very-low-quality evidence, downgraded for indirectness and imprecision) did not find any improvement in mortality with improved admission temperatures, but they were not sufficiently powered for this outcome.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 7: Neonatal Resuscitation

Perlman¹,

Wyllie²,

Kattwinkel³

et al. 2015

Circulation

533

256

View full text Add to dashboard Cite

The transition from intrauterine to extrauterine life that occurs at the time of birth requires timely anatomic and physiologic adjustments to achieve the conversion from placental gas exchange to pulmonary respiration. This transition is brought about by initiation of air breathing and cessation of the placental circulation. Air breathing initiates marked relaxation of pulmonary vascular resistance, with considerable increase in pulmonary blood flow and increased return of now-welloxygenated blood to the left atrium and left ventricle, as well as increased left ventricular output. Removal of the lowresistance placental circuit will increase systemic vascular resistance and blood pressure and reduce right-to-left shunting across the ductus arteriosus. The systemic organs must equally and quickly adjust to the dramatic increase in blood pressure and oxygen exposure. Similarly, intrauterine thermostability must be replaced by neonatal thermoregulation with its inherent increase in oxygen consumption.Approximately 85% of babies born at term will initiate spontaneous respirations within 10 to 30 seconds of birth, an additional 10% will respond during drying and stimulation, approximately 3% will initiate respirations after positive-pressure ventilation (PPV), 2% will be intubated to support respiratory function, and 0.1% will require chest compressions and/or epinephrine to achieve this transition. [1][2][3] Although the vast majority of newborn infants do not require intervention to make these transitional changes, the large number of births worldwide means that many infants require some assistance to achieve cardiorespiratory stability each year.Newly born infants who are breathing or crying and have good tone immediately after birth must be dried and kept warm so as to avoid hypothermia. These actions can be provided with the baby lying on the mother's chest and should not require separation of mother and baby. This does not preclude the need for clinical assessment of the baby. For the approximately 5% of newly born infants who do not initiate respiratory effort after stimulation by drying, and providing warmth to avoid hypothermia, 1 or more of the following actions should be undertaken: providing effective ventilation with a face mask or endotracheal intubation, and administration of chest compressions with or without intravenous medications or volume expansion for those with a persistent heart rate less than 60/min or asystole, despite strategies to achieve effective ventilation (Figure 1).The 2 vital signs that are used to identify the need for an intervention as well as to assess the response to interventions are heart rate and respirations. Progression down the algorithm should proceed only after successful completion of each step, the most critical being effective ventilation. A period of only approximately 60 seconds after birth is allotted to complete each of the first 2 steps, ie, determination of heart rate and institution of effective ventilation. Subsequent progression to the next step will depend o...

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Randomized Trial of Occlusive Wrap for Heat Loss Prevention in Preterm Infants

Abstract: Application of occlusive wrap to very preterm infants immediately after birth results in greater mean body temperature but does not reduce mortality.

Cited by 81 publications

References 23 publications

Part 13: Neonatal Resuscitation

Part 13: Neonatal Resuscitation

Part 7: Neonatal Resuscitation

Part 7: Neonatal Resuscitation

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