Prevention of Hypothermia in Infants <30 weeks Gestation

Reviewed by Bronwyn Jones (NNP) and Malcom Battin

August
2005

Introduction	Which Babies	When and How to Apply	In the Operating Theatre
In Delivery Unit	When CPAP is Required	When to Remove the Wrap	References

Introduction

Hypothermia in the premature newborn is associated with increased mortality and morbidity. ¹
In infants <1500g, temperatures on admission to the neonatal unit are on average <35.5°C.
Polyethylene wraps have been shown to be an effective intervention in improving core temperature on admission to neonatal units. ²

Which Babies

This guideline applies to infants born at <30 weeks gestation at National Women’s Health in either delivery unit or theatre and - if practical - elsewhere in Auckland City Hospital (e.g. antenatal wards, WAU or ED).

When and How to Apply

Plastic wrap should be pre-warmed.
Note that the infant is not dried prior to being placed in the wrap.

Baby wrapped without drying wrapping the head first.
Sides wrapped in similar fashion as one would when using a towel.
Infant is resuscitated in plastic wrap.
Heart-rate can be auscultated through plastic.
A SaO₂ probe should be applied to the right arm/hand as soon as possible following delivery via the bottom of the wrapped infant. Vitamin K should be given in the Newborn Unit. (Note this should be prescribed on the stat dose side of the drug sheet). Temperature should be taken immediately on arrival in the NICU and again at 1 hour.

In the Operating Theatre

In theatre the infant is transferred to the radiant warmer and placed on a plastic wrap that has been pre-warmed.

Plastic wrap pre-warmed on heat table.

Prewarmed plastic on heat table

In Delivery Unit

In the Delivery Unit the infant is wrapped in warmed plastic wrap directly at mother’s bedside in the same manner as outlined above.
The infant is then transferred to the radiant warmer for immediate management.

When CPAP is Required

If CPAP is required the babies head should be dried and CPAP bonnet applied in the usual way keeping the babies body wrapped in plastic.

When to Remove Wrap

When the infant is stabilised in the neonatal unit in either a humidified incubator or heat table the plastic can be removed.
Drying the infant is not necessary.
Admission temperature and temperature at 1 hour should be recorded and care must be taken not to overheat the infant.

References

1	Costeloe K, Hennessy E, Gibson A, Marlow N, Wilkinson A. The EPICure Study: Outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 2000;106(4):659
2	McCall E, Alderdice F, Halliday H, Jenkins J, Vohra S. Interventions to prevent hypothermia at birth in preterm and/or low birthweight babies. The Cochrane Database of Systematic Reviews 2005.