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Mishra U, August D, Walker K, Jani PR, Tracy M. Thermoregulation, incubator humidity, and skincare practices in appropriate for gestational age ultra-low birth weight infants: need for more evidence. World J Pediatr 2024; 20:643-652. [PMID: 38864998 PMCID: PMC11269412 DOI: 10.1007/s12519-024-00818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/13/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Although not universal, active care is being offered to infants weighing < 500 g at birth, referred to as ultra-low birth weight (ULBW) infants appropriate for gestational age. These infants have the greatest risk of dying or developing major morbidities. ULBW infants face challenges related to fluid and heat loss as well as skin injury in the initial days of life from extreme anatomical and physiological immaturity of the skin. Although there is an emerging literature on the outcomes of ULBW infants, there is a paucity of evidence to inform practice guidelines for delivering optimal care to this cohort of infants. DATA SOURCES A comprehensive review of the literature was performed using the PubMed and Embase databases. Searched keywords included "thermoregulation or body temperature regulation", "incubator humidity", "skin care", "infant, extremely low birth weight" and "ultra-low birth weight infants". RESULTS Evidences for thermoregulation, incubator humidity, and skincare practices are available for preterm infants weighing < 1500 g at birth but not specifically for ULBW infants. Studies on thermoregulation, incubator humidity, or skincare practices had a small sample size and did not include a sub-group analysis for ULBW infants. Current practice recommendations in ULBW infants are adopted from research in very and/or extremely low birth weight infants. CONCLUSIONS This narrative review focuses on challenges in thermoregulation, incubator humidity, and skincare practices in ULBW infants, highlights current research gaps and suggests potential developments for informing practices for improving health outcomes in ULBW infants. Video abstract (MP4 1,49,115 kb).
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Affiliation(s)
- Umesh Mishra
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
| | - Deanne August
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
| | - Karen Walker
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Newborn Care, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Pranav R Jani
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia.
| | - Mark Tracy
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
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Carneiro L, Al Sarout S, Jeanneaud C, Clenet N, Favrais G. Skin-to-Skin Contact for Transferring Preterm Infants from the Delivery Room to the Neonatal Intensive Care Unit Is Promising Despite Moderate Heat Loss during the Procedure. Am J Perinatol 2024; 41:e1037-e1044. [PMID: 36384235 DOI: 10.1055/a-1979-8433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The principal aim of this prospective observational study was to assess the feasibility of skin-to-skin contact (SSC) with fathers during the transfer of preterm infants from the delivery room to the neonatal intensive care unit (NICU) in comparison with incubator transfers. STUDY DESIGN The study population comprised preterm singletons born between May and December 2019 in our maternity ward who did not require invasive ventilation. Physiological parameters (axillary temperature, heart rate, and fraction of inspired oxygen) of the newborns were recorded at prespecified steps during the transfers. The impact of the transfer mode on early blood glucose level, blood gas, and neonatal morbidities and mortality and the delay in the first SSC in the NICU and breastfeeding implementation and maintenance were also analyzed. RESULTS Twenty-eight preterm infants were transferred in incubators, and 29 infants were transferred using SSC. The SSC transfer induced heat loss (mean, -0.45°C; standard deviation [SD], 0.58). However, the decrease in temperature was similar to that observed during transfer in the incubator (mean, -0.30°C; SD, 0.49; p = 0.3). The transfer using SSC was not an independent factor associated with hypothermia at admission in the NICU (adjusted odds ratio, 2.6 [0.68-9.75]; p = 0.16). Neonatal morbidities and mortality were similar regardless of the transfer mode. The SSC transfer promoted early SSC in the neonatal unit (median hour [range], incubator 26 [2-126] vs SSC 13 [1-136], p = 0.03) and breastfeeding at discharge (incubator 35.7% vs SSC 69%, p = 0.01). CONCLUSION The SSC transfer of preterm infants was feasible and promoted earlier SSC and breastfeeding. Nevertheless, the SSC transfer, like the transfer in the incubator, induced moderate heat losses that exacerbated hypothermia at admission in the NICU. The improvement of thermal conservation during infant positioning and the continuation of SSC in the unit could help in preventing hypothermia. KEY POINTS · The SSC transfer was associated with heat loss during the transfer procedure.. · The SSC transfer promoted earlier SSC in the neonatal unit.. · The SSC transfer was likely to encourage breastfeeding..
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Affiliation(s)
- Laure Carneiro
- Neonatology Unit, Centre Hospitalo-Universitaire et Régional de Tours, Tours, France
| | - Safaa Al Sarout
- Neonatology Unit, Centre Hospitalo-Universitaire et Régional de Tours, Tours, France
| | - Carole Jeanneaud
- Clinical research department, Centre Hospitalo-Universitaire et Régional de Tours, Tours, France
| | - Nolwenn Clenet
- Neonatology Unit, Centre Hospitalo-Universitaire et Régional de Tours, Tours, France
| | - Geraldine Favrais
- Neonatology Unit, Centre Hospitalo-Universitaire et Régional de Tours, Tours, France
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France
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Sheng L, Zhong G, Xing R, Yan X, Cui H, Yu Z. Quality improvement in the golden hour for premature infants: a scoping review. BMC Pediatr 2024; 24:88. [PMID: 38302960 PMCID: PMC10832117 DOI: 10.1186/s12887-024-04558-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Evidence-based research has shown that golden hour quality improvement (QI) measures can improve the quality of care and reduce serious complications of premature infants. Herein, we sought to review golden hour QI studies to evaluate the impact on the outcome of preterm infants. METHODS A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and SinoMed databases from inception to April 03, 2023. Only studies describing QI interventions in the golden hour of preterm infants were included. Outcomes were summarized and qualitative synthesis was performed. RESULTS Ten studies were eligible for inclusion. All studies were from single centers, of which nine were conducted in the USA and one in Israel. Seven were pre-post comparative studies and three were observational studies. Most included studies were of medium quality (80%). The most common primary outcome was admission temperatures and glucose. Five studies (n = 2308) reported improvements in the admission temperature and three studies (n = 2052) reported improvements in hypoglycemia after QI. Four studies (n = 907) showed that the incidence of bronchopulmonary dysplasia (BPD) was lower in preterm infants after QI: 106/408 (26.0%) vs. 122/424(29.5%) [OR = 0.68, 95% CI 0.48-0.97, p = 0.04]. CONCLUSIONS Our study showed that the golden hour QI bundle can improve the short-term and long-term outcomes for extremely preterm infants. There was considerable heterogeneity and deficiencies in the included studies, and the variation in impact on outcomes suggests the need to use standardized and validated measures. Future studies are needed to develop locally appropriate, high-quality, and replicable QI projects.
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Affiliation(s)
- Lijuan Sheng
- Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Guichao Zhong
- Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Ruirui Xing
- Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Xudong Yan
- Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Huanjin Cui
- Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Zhangbin Yu
- Department of Neonatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
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Liu J, Wu S, Zhu X. Advances in the Prevention and Treatment of Neonatal Hypothermia in Early Birth. Ther Hypothermia Temp Manag 2022; 12:51-56. [PMID: 35384724 DOI: 10.1089/ther.2021.0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Neonates are vulnerable to hypothermia in the early postnatal period due to a low temperature environment, physiological function, and many other factors. In this article, the definition, occurrence status, related factors, hazards, and prevention strategies of neonatal hypothermia are reviewed. The interventions for hypothermia are mainly achieved through three processes, that is, intervention in the delivery room before and after birth, intervention on the way from the delivery room to the neonatal intensive care unit (NICU), and intervention after arrival at the NICU. Rewarming is the main intervention measure after the occurrence of hypothermia and slow rewarming is advocated, based on related studies of early neonatal cold injury syndrome and mild hypothermia treatment of hypoxic-ischemic encephalopathy. Rapid rewarming has been proposed in recent years but remains controversial. There are no detailed guidelines yet for rewarming for early neonatal hypothermia, and there is no precise definition of "rapid rewarming" and "slow rewarming" in terms of the rewarming rate.
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Affiliation(s)
- Jianhong Liu
- Department of Neonatology, Jingzhou Central Hospital, The Second Hospital of Yangtze University, Jingzhou, China
| | - Shanshan Wu
- Department of Neonatology, Jingzhou Central Hospital, The Second Hospital of Yangtze University, Jingzhou, China
| | - Xiaofang Zhu
- Department of Neonatology, Jingzhou Central Hospital, The Second Hospital of Yangtze University, Jingzhou, China
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Reducing Admission Hypothermia in Neonates Born at Less Than 32 Weeks or 1500 g. Adv Neonatal Care 2022; 22:99-107. [PMID: 33783381 DOI: 10.1097/anc.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this quality improvement project was to decrease admission hypothermia in neonates born at less than 32 weeks or less than 1500 g. METHODS At delivery, neonates born less than 1500 g or at less than 32 weeks received polyurethane bags, polyurethane hats, and chemical mattresses. New practice guidelines from 2016 promoted this practice for all neonates born at less than 32 weeks, but the authors' prior work indicated that all neonates born less than 1500 g were at risk (regardless of gestational age) and would benefit from these interventions. FINDINGS/RESULTS After the intervention, only 2.1% (n = 2) of neonates born less than 1500 g or at less than 32 weeks were admitted moderately hypothermic (<36°C) compared with 9.6% in 2016, 20.2% in 2015, and 32.4% in 2014. Overall, the mean admission temperature in 2017 was 37°C, improved from 36.6°C in 2016, 36.3°C in 2015, and 36.2°C in 2014 (P < .001). IMPLICATIONS FOR PRACTICE The intervention significantly reduced the number of neonates admitted moderately hypothermic (<36.0°C) to this neonatal intensive care unit. Using chemical mattresses and polyurethane bags with neonates born less than 1500 g or at less than 32 weeks (compared with only <1000 g) improved admission temperatures. It is important to include all neonates born less than 1500 g in these practice interventions and not only those born at less than 32 weeks; both gestational age and weight should guide practice. IMPLICATIONS FOR RESEARCH More research is needed on the effects of thermoregulation interventions and hyperthermia in neonates, as well as best practice thermoregulation interventions for preterm and ill neonates of all gestational ages and weights.
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Cavallin F, Doglioni N, Allodi A, Battajon N, Vedovato S, Capasso L, Gitto E, Laforgia N, Paviotti G, Capretti MG, Gizzi C, Villani PE, Biban P, Pratesi S, Lista G, Ciralli F, Soffiati M, Staffler A, Baraldi E, Trevisanuto D. Thermal management with and without servo-controlled system in preterm infants immediately after birth: a multicentre, randomised controlled study. Arch Dis Child Fetal Neonatal Ed 2021; 106:572-577. [PMID: 33597230 DOI: 10.1136/archdischild-2020-320567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/29/2020] [Accepted: 01/31/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The thermal servo-controlled systems are routinely used in neonatal intensive care units (NICUs) to accurately manage patient temperature, but their role during the immediate postnatal phase has not been previously assessed. OBJECTIVE To compare two modalities of thermal management (with and without the use of a servo-controlled system) immediately after birth. STUDY DESIGN AND SETTING Multicentre, unblinded, randomised trial conducted 15 Italian tertiary hospitals. PARTICIPANTS Infants with estimated birth weight <1500 g and/or gestational age <30+6 weeks. INTERVENTION Thermal management with or without a thermal servo-controlled system during stabilisation in the delivery room. PRIMARY OUTCOME Proportion of normothermia at NICU admission (axillary temperature 36.5°C-37.5°C). RESULTS At NICU admission, normothermia was achieved in 89/225 neonates (39.6%) with the thermal servo-controlled system and 95/225 neonates (42.2%) without the thermal servo-controlled system (risk ratio 0.94, 95% CI 0.75 to 1.17). Thermal servo-controlled system was associated with increased mild hypothermia (36°C-36.4°C) (risk ratio 1.48, 95% CI 1.09 to 2.01). CONCLUSIONS In very low birthweight infants, thermal management with the servo-controlled system conferred no advantage in maintaining normothermia at NICU admission, while it was associated with increased mild hypothermia. Thermal management of preterm infants immediately after birth remains a challenge. TRIAL REGISTRATION NUMBER NCT03844204.
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Affiliation(s)
| | - Nicoletta Doglioni
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | | | - Nadia Battajon
- Pediatric Department, Ospedale Regionale Ca Foncello Treviso, Treviso, Veneto, Italy
| | - Stefania Vedovato
- Pediatric Department, Ospedale San Bortolo di Vicenza, Vicenza, Veneto, Italy
| | - Letizia Capasso
- Translational Medical Sciences, University "Federico II", Napoli, Italy
| | - Eloisa Gitto
- Department of Pediatrics, University of Messina, Neonatal Intensive Care Unit, Messina, Italy
| | | | - Giulia Paviotti
- Department of Neonatology, Azienda Ospedaliera Universitaria Integrata di Udine, Udine, Italy
| | - Maria Grazia Capretti
- Department of Medical and Surgical Sciences, Operative Unit of Neonatology, University of Bologna, Bologna, Italy
| | - Camilla Gizzi
- NICU, "S. Giovanni Calibita" Hospital - Fatebenefratelli Isola Tiberina, Rome, Italy
| | | | - Paolo Biban
- Department of Pediatrics, PICU-NICU, University Hospital of Verona, Verona, Italy
| | - Simone Pratesi
- Division of Neonatology, Careggi University Hospital, Florence, Italy
| | - Gianluca Lista
- Department of Pediatrics, Ospedale dei Bambini "V.Buzzi", Milano, Italy
| | - Fabrizio Ciralli
- Dipartimento Donna-Bambino-Neonato, Ospedale Maggiore Policlinico, Milano, Lombardia, Italy
| | - Massimo Soffiati
- Division of Pediatrics, S. Chiara General Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Trentino-Alto Adige, Italy
| | - Alex Staffler
- Division of Neonatology, Azienda Sanitaria dell'Alto Adige di Bolzano, Bolzano, Italy
| | - Eugenio Baraldi
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Daniele Trevisanuto
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
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Heo JS, Kim SY, Park HW, Choi YS, Park CW, Cho GJ, Oh AY, Jang EK, Kim HS, Kim ARE, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 8. Neonatal resuscitation. Clin Exp Emerg Med 2021; 8:S96-S115. [PMID: 34034452 PMCID: PMC8171175 DOI: 10.15441/ceem.21.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/05/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- Ju Sun Heo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Su Yeong Kim
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye Won Park
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Ah Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyung Jang
- Office of Patient Safety, Yonsei University Severance Hospital, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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