Drying Very Preterm Infants Before Plastic Wrapping at Birth: A Randomized Clinical Trial

Area of Science:

• Neonatology
• Perinatal care
• Thermoregulation

Background:

• Maintaining thermal stability in preterm infants immediately after birth is a persistent challenge despite advancements in neonatal care.
• Effective thermal management strategies are crucial for improving outcomes in very preterm infants.

Purpose of the Study:

• To compare the efficacy of two thermal management strategies: plastic wrapping with drying versus plastic wrapping without drying.
• To assess the impact of these strategies on preventing heat loss in very preterm infants at birth.

Main Methods:

• A multicenter, unblinded, randomized clinical trial involving very preterm infants (birth weight <1500 g or gestational age ≤30 weeks 6 days).
• Infants were randomized to either drying before plastic wrapping or plastic wrapping without drying in the delivery room.
• The primary outcome was normothermia (36.5-37.5 °C) at neonatal intensive care unit (NICU) admission.

Main Results:

• Normothermia at NICU admission was similar between the dried (45.8%) and undried (46.3%) groups (risk ratio, 0.99; 95% CI, 0.79-1.24).
• Mean temperatures at NICU admission were also comparable: 36.4 °C (dried) vs. 36.5 °C (undried).
• In-hospital mortality was higher in the dried group (14.7%) compared to the undried group (5.6%).

Conclusions:

• Drying very preterm infants before plastic wrapping does not improve normothermia rates upon NICU admission.
• Thermal management remains a significant challenge for very preterm infants, with approximately half outside the normal temperature range at NICU admission.
• Further research is needed to identify optimal thermal management strategies for this vulnerable population.