Randomized Trial of Plastic Bags to Prevent Term Neonatal Hypothermia in a Resource-Poor Setting

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Term neonates in resourcepoor settings frequently develop hypothermia. 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. WHAT THIS STUDY ADDS:For term neonates born in a resourcepoor health facility, placement in a plastic bag at birth can reduce the incidence of hypothermia at 1 hour after birth. abstract OBJECTIVES: Term infants in resource-poor settings 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 resource-poor hospital.METHODS: This parallel-group randomized 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 randomized 1:1 to either a standard thermoregulation protocol or to a standard 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 randomized to plastic bag (n = 135) or to standard 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 6 0.5°C vs 36.2 6 0.7°C, P , .001) at 1 hour after birth compared with infants receiving standard 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 resource-poor setting, but most neonates remained hypothermic.

Part 13: Neonatal Resuscitation

“…Simple interventions to prevent hypothermia during transition (birth until 1 to 2 hours of life) reduce mortality. During transition, the use of plastic wraps [90][91][92] and the use of skin-to-skin contact [93][94][95][96][97][98][99][100] reduce hypothermia. In resource-limited settings, to maintain body temperature or prevent hypothermia during transition (birth until 1 to 2 hours of life) in well newborn infants, it may be reasonable to put them in a clean food-grade plastic bag up to the level of the neck and swaddle them after drying (Class IIb, LOE C-LD).…”

Part 7: Neonatal Resuscitation

“…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 [131][132][133] enrolling 409 newborns of greater than 30 weeks of gestation, showing either a reduction in incidence of hypothermia with plastic after drying 131,132 (RR, 0.77; 95% CI, 0.65-0.90) or no difference in temperature 133 with plastic with or without drying compared with cot bed or open crib and swaddling with or without initial use of radiant warmer.…”

Part 7: Neonatal Resuscitation

“…During transition (from birth to 1-2 hours after delivery), we identified verylow-quality evidence (downgraded for risk of bias, inconsistency, and imprecision) from 3 randomized clinical trials [131][132][133] enrolling 409 newborns of greater than 30 weeks of gestation, showing either a reduction in incidence of hypothermia with plastic after drying 131,132 (RR, 0.77; 95% CI, 0.65-0.90) or no difference in temperature 133 with plastic with or without drying compared with cot bed or open crib and swaddling with or without initial use of radiant warmer.…”