Presented at the Neonatal Society 2005 Autumn Meeting.

Bomont RK, Kent S, Cheema IU

Acute Neonatal Transport Service, Addenbrookes Hospital, Cambridge CB2 2QQ, UK

Introduction: The importance of thermal management in preterm infants is well recognised. The use of plastic bags during initial resuscitation and stabilisation has been demonstrated to improve admission temperatures in infants less than 28 weeks gestation (1), and the subsequent clinical course of infants less than 26 weeks gestation (2). Thermal management during inter-hospital transport of such infants remains challenging.

Aim: To evaluate the use of polyethylene bags in aiding optimal thermal management during pre-transport stabilisation.

Design: For a six-month period from October 2004 to March 2005, infants of < 30 weeks gestation and <10 days of age were placed in plastic bags by the transport team at the earliest safe opportunity after its arrival at the referring hospital. This was prior to any non-urgent intervention. Infants remained in the bags until transferred to the receiving unit. Anterior abdominal wall temperature was continually monitored and recorded every 15 minutes and immediately following completion of each phase of the transfer, namely stabilisation (time between team’s arrival & infant being placed into transport incubator), after transfer into the transport incubator and on arrival at the receiving unit. The study group were compared with all similar transfers carried out by the team over the preceding 10 months. Trans-Warmer Mattresses were used as standard within the maximally pre-warmed transport incubator in both groups.

Results: The two groups were not similar. Infants in the study group were significantly smaller and more premature compared to the historical controls. One infant in the control group died during stabilisation. The temperatures of the two groups upon the transport team’s arrival at the referring hospital did not differ significantly. Significantly more infants placed in plastic bags had temperatures in the normal range immediately following stabilisation. The time taken for stabilisation did not differ significantly. There was no difference in the number of babies with normal temperatures on arrival at the receiving unit.

Conclusion: Achievement and maintenance of skin temperatures to >36.4ºC is significantly improved during the initial phases of the transport process when preterm infants are placed in plastic bags at the beginning of pre transport stabilisation.

References
1. Vohra S, Frent G, Campbell V, et al. J Pediatr 1999;134:547–51.
2. Costeloe K, Hennessy E, Gibson AT, et al. Pediatrics 2000;106:659–71.