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Published on: January 16, 2014
Randomized trial of occlusive wrap for heat loss prevention in preterm infants
Maureen C Reilly1, Sunita Vohra2, Valeria E Rac3
1Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Insights
Applying occlusive wrap to very preterm infants immediately after birth improved body temperature but did not reduce mortality. This intervention did not impact overall survival rates for premature infants.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Very preterm infants are at high risk for hypothermia and mortality.
- Maintaining thermal stability is crucial for neonatal outcomes.
- Previous interventions have aimed to improve temperature regulation in neonates.
Purpose of the Study:
- To evaluate the efficacy of immediate post-birth occlusive wrap application in reducing mortality in very preterm infants.
- To assess the impact of occlusive wrap on infant temperature and other secondary clinical outcomes.
Main Methods:
- Prospective randomized controlled trial involving infants born between 24 0/7 and 27 6/7 weeks' gestation.
- Infants were randomly assigned to receive either an occlusive wrap or no wrap immediately after birth.
- Primary outcome was all-cause mortality; secondary outcomes included temperature, Apgar scores, and various morbidities.
Main Results:
- No significant difference in mortality was observed between the occlusive wrap and no-wrap groups.
- Infants in the occlusive wrap group had significantly higher baseline and post-stabilization body temperatures.
- A significant decrease in pulmonary hemorrhage was noted in the wrap group, alongside a lower mean one-minute Apgar score.
Conclusions:
- Immediate application of occlusive wrap to very preterm infants increases mean body temperature.
- Occlusive wrap application does not reduce mortality in very preterm infants.
- The study was terminated early due to the inability to demonstrate a significant difference in the primary outcome.
Objective:
To determine whether the application of occlusive wrap applied immediately after birth will reduce mortality in very preterm infants.
Study Design:
This was a prospective randomized controlled trial of infants born 24 0/7 to 27 6/7 weeks' gestation who were assigned randomly to occlusive wrap or no wrap. The primary outcome was all cause mortality at discharge or 6 months' corrected age. Secondary outcomes included temperature, Apgar scores, pH, base deficit, blood pressure and glucose, respiratory distress syndrome, bronchopulmonary dysplasia, seizures, patent ductus arteriosus, necrotizing enterocolitis, gastrointestinal perforation, intraventricular hemorrhage, cystic periventricular leukomalacia, pulmonary hemorrhage, retinopathy of prematurity, sepsis, hearing screen, and pneumothorax.
Results:
Eight hundred one infants were enrolled. There was no difference in baseline population characteristics. There were no significant differences in mortality (OR 1.0, 95% CI 0.7-1.5). Wrap infants had statistically significant greater baseline temperatures (36.3°C wrap vs 35.7°C no wrap, P < .0001) and poststabilization temperatures (36.6°C vs 36.2°C, P < .001) than nonwrap infants. For the secondary outcomes, there was a significant decrease in pulmonary hemorrhage (OR 0.6, 95% CI 0.3-0.9) in the wrap group and a significant lower mean one minute Apgar score (P = .007) in the wrap group. The study was stopped early because continued enrollment would not result in the attainment of a significant difference in the primary outcome.
Conclusion:
Application of occlusive wrap to very preterm infants immediately after birth results in greater mean body temperature but does not reduce mortality.
