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Randomized trial of plastic bags to prevent term neonatal hypothermia in a resource-poor setting
Theodore C Belsches1, Alyssa E Tilly, Tonya R Miller
1Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
Insights
Plastic bags significantly reduced hypothermia in term neonates at one hour after birth in a resource-poor setting. However, most infants still experienced hypothermia despite this low-cost intervention.
Area of Science:
- Neonatal care
- Public health interventions
- Thermoregulation
Background:
- Hypothermia is a common problem for newborns in resource-poor settings.
- Plastic bags are a low-cost method to prevent hypothermia in preterm infants.
- This intervention's effectiveness in term infants in resource-poor areas is unknown.
Purpose of the Study:
- To determine if plastic bags reduce hypothermia in term neonates at 1 hour after birth.
- To test the hypothesis in a resource-poor hospital setting.
Main Methods:
- A randomized controlled trial was conducted in Zambia.
- Term neonates (≥37 weeks gestation, ≥2500g) were randomized to standard care or standard care plus a plastic bag.
- Hypothermia (<36.5°C axillary temperature) at 1 hour was the primary outcome.
Main Results:
- Neonates in the plastic bag group had a lower rate of hypothermia (60% vs. 73%, P=.026).
- The plastic bag group had higher axillary temperatures at 1 hour (36.4°C vs. 36.2°C, P<.001).
- Baseline characteristics were similar between groups.
Conclusions:
- Plastic bag use at birth reduced hypothermia incidence in term neonates in a resource-poor setting.
- Despite the intervention, a majority of neonates remained hypothermic at 1 hour.
Objectives:
Term infants in resource-poor settings frequently develop hypothermia during the first hours after birth. Plastic bags or wraps are a low-cost intervention for the prevention of hypothermia in preterm and low birth weight infants that may also be effective in term infants. Our objective was to test the hypothesis that placement of term neonates in plastic bags at birth reduces hypothermia at 1 hour after birth in a resource-poor hospital.
Methods:
This parallel-group randomized controlled trial was conducted at University Teaching Hospital, the tertiary referral center in Zambia. Inborn neonates with both a gestational age ≥37 weeks and a birth weight ≥2500 g were randomized 1:1 to either a standard thermoregulation protocol or to a standard thermoregulation protocol with placement of the torso and lower extremities inside a plastic bag within 10 minutes after birth. The primary outcome was hypothermia (<36.5°C axillary temperature) at 1 hour after birth.
Results:
Neonates randomized to plastic bag (n = 135) or to standard thermoregulation care (n = 136) had similar baseline characteristics (birth weight, gestational age, gender, and baseline temperature). Neonates in the plastic bag group had a lower rate of hypothermia (60% vs 73%, risk ratio 0.76, confidence interval 0.60-0.96, P = .026) and a higher axillary temperature (36.4 ± 0.5°C vs 36.2 ± 0.7°C, P < .001) at 1 hour after birth compared with infants receiving standard care.
Conclusions:
Placement in a plastic bag at birth reduced the incidence of hypothermia at 1 hour after birth in term neonates born in a resource-poor setting, but most neonates remained hypothermic.
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