Acceptability and feasibility Kangaroo Mother Care

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5.9 Prevention of hypothermia immediately after birth in low birth

weight infants Low birth weight LBW neonates weighing 1200 g who do not have complications and are clinically stable should be put in skin-to-skin contact with the mother soon ater birth and ater drying them thoroughly to prevent neonatal hypothermia. Strong recommendation, low quality evidence In making the recommendation, the panel noted that although the plastic wraps for LBW infants are beneicial in reducing hypothermia, the possible risks of using plastic wraps in settings in developing country were not known. here is very little experience with this intervention in developing countries and further research into the type of plastic to be used, as well as the practicality and appropriateness of using the plastic-wrap technique in low-resource settings, is required.

5.9.1 Evidence and summary of findings

We identiied one recent systematic review through Cochrane [McCall 2010] that sought to assess the efect on interventions to prevent hypothermia in preterm andor LBW infants. he review included three interventions of interest: 1 plastic wraps; 2 plastic caps; and 3 skin-to-skin contact. Studies were included that evaluated these interventions started within 10 minutes of birth. Hypothermia was deined as core body temperature 36.5 °C on admission to neonatal intensive care unit NICU or up to 2 hours ater birth. here was low to moderate quality evidence that caps or plasticwraps reduced hypothermia, and moderate quality evidence that skin to skin contact signiicantly reduced hypothermia in LBW newborns GRADE table A7.7 Plastic wraps or bags were efective in reducing heat loss in infants 28 weeks’ gestation four studies; n = 223; WMD 0.68 °C; 95 CI 0.45, 0.91, but not in infants between 28 to 31 weeks gestation 1 study, n = 41. Two of the studies in infants of gestational age 29 weeks showed that plastic wrap signiicantly reduces the risk of hypothermia on admission to the NICU two studies, n = 152; RR 0.66, 95 CI 0.51, 0.84; RD -0.27; 95 CI -0.41, -0.13 . Four infants would need to be wrapped in plastic in order to prevent one infant from becoming hypothermic NNT 4, 95 CI 2 to 8. Plastic caps were efective in reducing heat losses in infants 29 weeks’ gestation one study; n = 64; MD 0.80°C; 95 CI 0.41, 1.19. his study also reported that plastic caps signiicantly reduce the risk of hypothermia on admission to the NICU RR 0.48, 95 CI 0.32, 0.73; RD -0.47; 95 CI -0.67, -0.27. Two infants would need to wear a plastic cap in order to prevent one infant from becoming hypothermic NNT 2, 95 CI 2 to 4. For infants with a birth weight between 1200 and 2199g, evidence suggests that skin-to-skin contact signiicantly reduces the risk of hypothermia as deined by the study within 6 hours of birth when compared to conventional incubator care one study; n = 31; RR 0.09, 95 CI 0.01, 0.64; RD -0.56, 95 CI -0.84, -0.27. Two infants would need to receive skin-to-skin contact in order to prevent one infant from becoming hypothermic NNT 2, 95 CI 1 to 4. 35

5.9.2 Benefits and risks

Benefits Plastic wrap or plastic cap used immediately ater birth prevents hypothermia in infants of gestation 29 weeks. For LBW infants above 1200 g, skin-to-skin contact immediately ater birth efectively prevents hypothermia. Risks No evidence of reported harms was available.

5.9.3 Acceptability and feasibility

Plastic wraps are relatively of low cost, may be easy to use and acceptable to parents of LBW newborns.