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Changes in body temperature immediately after birth in preterm infants resuscitated in polythene bags

Presented at the Neonatal Society 2004 Summer Meeting (programme).

McCrosson F, Quine D, Smith CL, Armstrong L, Lyon A, Stenson B

Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK

Background: Low admission temperature is an independent risk factor for death in preterm infants (1). The use of polythene bags during resuscitation enhances thermal stability (2), but concerns have been raised that it may induce potentially damaging hyperthermia (3).

Aims: To measure the changes in body temperature immediately after birth in infants <29 weeks gestation who were resuscitated in polythene bags and to quantify the extent of any associated iatrogenic hyperthermia.

Methods: In a prospective study, infants <29 weeks gestation were laid on a temperature probe within a polythene bag immediately after birth and were then resuscitated under a radiant heater set to maximum. Sub-scapular temperature was documented every minute during the first 15 minutes of life.

Results: In an 8 month period to May 2004, 27 infants (14 males, 13 females) were studied. The mean (range) gestation and birth weight were 26+4 weeks (24 - 28+5) and 916g (490-1470). The mean (range) temperature at 15 minutes was 37.3C (36.3-38.1). No infant became hypothermic. 16/27 infants had temperatures that never exceeded 37.5C. 8/27 (30%) infants had initial temperatures above 37.5C: 5 of them cooled gradually during resuscitation towards 37C, the remaining 3 warmed by 0.2C, 0.3C and 0.4C to a maximum of 38C. 3/27 infants with normal initial temperatures warmed during stabilisation to temperatures above 37.5C. The increases in temperature were 0.2C, 0.6C & 0.6C and the maximum temperature reached was 38.1C. One of these 3 infants died at 6 hrs of age from proven group B streptococcal disease.

Conclusions: The use of polythene bags can eliminate hypothermia during resuscitation in preterm infants. A significant proportion of babies (30%) have a high temperature before stabilisation. Iatrogenic temperature increases during resuscitation occur in a minority of infants and are small. The maximum iatrogenic increase in temperature was 0.6C.

1. Costeloe K, Hennessy E, Gibson AT, et al. The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 2000;196:659-71.
2. A J Lyon and B Stenson.Cold comfort for babies. Arch. Dis. Child. Fetal Neonatal Ed., Jan 2004; 89: F93.
3. T Newton and M Watkinson. Preventing hypothermia at birth in preterm babies: at a cost of overheating some? Arch. Dis. Child. Fetal Neonatal Ed., May 2003; 88: F256.

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