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Plastic Versus Cotton Caps for Preventing Hypothermia in Very Preterm Infants: A Randomized Clinical Trial
Roya Farhadi1, Atekeh Hadinezhad2, Mahmood Moosazadeh3
1Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Insights
Plastic caps, combined with polyethylene body wrapping, slightly increased admission temperatures in very preterm infants compared to cotton caps. However, neither cap type significantly reduced hypothermia rates, indicating a need for novel strategies, especially for extremely preterm infants.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Preventing hypothermia in very preterm infants is a critical challenge in neonatal care.
- Effective thermal management is essential for improving outcomes in vulnerable newborns.
Purpose of the Study:
- To compare the efficacy of plastic versus cotton caps, when used with polyethylene body wrapping, in preventing hypothermia in very preterm infants.
- To evaluate the impact of different cap materials on infant temperature at admission and one hour post-admission.
Main Methods:
- A randomized clinical trial involving 95 newborns with gestational age less than 32 weeks.
- Infants were wrapped in polyethylene covers immediately after birth.
- Intervention group received plastic caps; control group received cotton caps.
Main Results:
- Plastic caps were associated with higher mean axillary temperatures on admission compared to cotton caps (P = .009).
- This temperature difference was significant for infants aged 28-31 weeks' gestation (P = .013).
- No significant difference in hypothermia rates or temperature at 1 hour post-admission was observed between the groups.
Conclusions:
- While plastic caps may offer a slight advantage in admission temperature, they do not significantly reduce hypothermia frequency in very preterm infants.
- Novel and combined thermal management strategies are needed, particularly for extremely preterm infants (25-27 weeks' gestation).
- Plastic caps are a cost-effective and hygienic option for resource-limited settings.
Objective:
Preventing hypothermia in very preterm infants is difficult. This study aims to compare the effect of plastic versus cotton caps in combination with polyethylene body wrapping in the prevention of hypothermia in very preterm infants.
Materials And Methods:
A total of 95 newborns less than 32 weeks of gestation were enrolled in this randomized clinical trial. Immediately after birth, the infants were placed in polyethylene covers. In the intervention group (n=48), the heads of newborns were covered with plastic caps, while in the control group (n=47), the heads were covered with cotton caps. The primary outcomes were temperature at admission and 1 hour after admission in the neonatal intensive care unit, as well as the rate of hypothermia in both groups.
Results:
Mean axillary temperature on admission was higher in the plastic cap group compared to the cotton cap group (P = .009). After adjusting for gestational age, the difference in mean admission temperature was higher in the plastic cap group in the 28-31 weeks' gestation (P = .013); however, all babies born at 25-27 weeks' gestation remained hypothermic at neonatal intensive care unit admission. The temperature 1 hour after admission was similar between the groups (P=.846). The rate of hypothermia showed no significant difference between groups.
Conclusion:
Although plastic caps were associated with higher admission temperatures compared with cotton caps, they did not reduce the frequency of hypothermia. This points to the need for newer and combined strategies, especially in extremely preterm infants (25-27 weeks). Plastic caps remain a cost-effective and hygienic option for resource-limited settings. Trial registration: The trial was prospectively registered in the Iranian Registry of Clinical Trials (IRCT) under the registration number IRCT20091201002801N5 on February 9, 2023. The registration can be accessed at the following URL: https://irct.behdasht.gov.ir/trial/68485.
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