Elsevier

The Journal of Pediatrics

Volume 145, Issue 6, December 2004, Pages 750-753
The Journal of Pediatrics

Original Article
Heat Loss Prevention (HeLP) in the delivery room: A randomized controlled trial of polyethylene occlusive skin wrapping in very preterm infants

https://doi.org/10.1016/j.jpeds.2004.07.036Get rights and content

Objectives

To determine if polyethylene occlusive skin wrapping of very preterm infants prevents heat loss after delivery better than conventional drying and to evaluate if any benefit is sustained after wrap removal.

Study design

This was a randomized controlled trial of infants <28 weeks' gestation. The experimental group was wrapped from the neck down. Only the head was dried. Control infants were dried completely. Rectal temperatures were compared on admission to the neonatal intensive care unit immediately after wrap removal and 1 hour later.

Results

Of 55 infants randomly assigned (28 wrap, 27 control), 2 died in the delivery room and 53 completed the study. Wrapped infants had a higher mean rectal admission temperature, 36.5°C (SD, 0.8°C), compared with 35.6°C (SD, 1.3°C) in control infants (P = .002). One hour later, mean rectal temperatures were similar in both groups (36.6°C, SD, 0.7°C vs 36.4°C, SD, 0.9°C, P = .4). Size at birth was an important determinant of heat loss: Mean rectal admission temperature increased by 0.21°C (95% CI, 0.04 to 0.4) with each 100-g increase in birth weight.

Conclusions

Polyethylene occlusive skin wrapping prevents rather than delays heat loss at delivery in very preterm infants.

Section snippets

Setting and participants

The Heat Loss Prevention (HeLP) study was conducted at McMaster University Medical Center in Hamilton, Ontario, Canada, from February 1999 to March 2000. Infants <28 weeks' gestation were potentially eligible if they were born in the study center. Infants whose delivery was not attended by the neonatal team were excluded from enrollment. The protocol also prescribed that infants were to be excluded if they had major congenital anomalies that were not covered by skin (eg, gastroschisis,

Participant flow

Figure 1 summarizes the flow of participants through the screening stage, enrollment, and completion of the study protocol. One infant who was randomly assigned to the no-wrap group was wrapped in error but analyzed according to the intended treatment. All patients were followed until death or discharge, whichever occurred first. Table I shows that the baseline characteristics of the infants and their mothers were similar in both groups.

Outcomes

The mean rectal temperature on admission to the NICU was

Discussion

We have confirmed that polyethylene occlusive skin wrapping of very preterm infants immediately after birth provides better thermal protection in the delivery room than conventional drying. Moreover, we have shown that wrapping prevents rather than just delays heat loss after very preterm birth. Wrapped infants maintained their core temperature after admission to the NICU and after wrap removal in a closed incubator. The HeLP study is the second randomized trial of this intervention. We

References (11)

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Supported by the Neonatal Resuscitation Program of the American Academy of Pediatrics.

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