Presented at the Neonatal Society 2007 Autumn Meeting.
Leslie A1, Wardle SP2, Budge H3, Marlow N3, Brocklehurst P1
1 NPEU, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK
2 Neonatal Intensive Care Unit, Nottingham University Hospitals, Nottingham, UK
3 Centre for Reproduction and Early Life, School of Human Development, University Hospital, Nottingham, UK
Background: Premature infants are at increased risk of hypothermia during resuscitation at bir th and there is a strong association between hypothermia on admission to NICU and subsequent death1. The use of polyethylene wrapping at delivery has been shown to improve admission temperature in preterm infants2 and has become standard practice. Studies of polyethylene wrap2 have shown a refractory group of infants who are cold on admission despite this intervention and there are little data on other techniques which might effectively preserve temperature.
Aim: To investigate whether use of a gel warming mattress (Transwarmer, Prism Technologies) in addition to routine thermal care during resuscitation at bir th increases temperature on admission to NICU of infants less than 29 weeks.
Methods: Infants all received standard thermal care at birth including radiant warmer, plastic bag and hat. Infants were randomised to intervention or control group, stratified by gestational age (≤26 weeks and >26 weeks). A blinded study pack opened at delivery determined whether infants received a study mattress. Infants in the control group did not receive a mattress. Temperature was measured on admission to NICU. The local research ethics committee approved the study and written informed parental consent was obtained for all infants.
Results: Forty-seven infants were recruited. There are no differences between the groups for birthweight (median (range): control 805g (560g – 1320g), mattress 840g (530g – 1240g)) or gestation at birth (control 26 weeks (23 – 28), mattress 26 weeks (23 – 28)).
The mean (95% CI) admission temperature in the control group was 36.7ºC (36.2 – 37.1) and in the mattress group was 37ºC (36.5 – 37.4). The number of infants whose admission temperature was below 36.5ºC was 6 (26%) in the study group and 10 (41%) in the control group. The number of infants whose temperature was above 38ºC was 3 (13%) in the study group and 3 (12%) in the control group. These are not significantly different. There were also no significant differences when infants ≤26 weeks and >26 weeks were analysed separately.
Conclusion: The addition of a gel warming mattress to standard thermal care does not result in significant improvement in admission temperature. In this study 34% of infants had admission temperature <36.5ºC. Further research is required to improve this aspect of care.
References
1. Costeloe K, Hennessey E, Gibson A, et al. Pediatrics 2000; 106: 659-671.
2. Vohra et al. J Pediatr 1999:134;547-551.