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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.
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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.