Hypothermia in the Low Birth Weight Premature Infant
Hypothermia in the Low Birth Weight Premature Infant
Low-birth-weight (LBW) premature infants are born without the adaptive mechanisms needed for survival outside of the womb. These fragile infants require thermoprotective interventions that begin in the delivery room. Current heat preservation interventions such as a pre-warmed delivery room, warm blankets/towels, drying, radiant warmer tables, and skin-to-skin with mother are not as effective in preserving heat in the smallest of infants. Despite the use of current heat preservation strategies, LBW premature infants remain vulnerable to hypothermia and associated morbidities and mortality. The use of an occlusive skin wrap has been studied since the late 1960's as a method for heat loss prevention in infants at birth. This evidentiary review will explore the most recent research on occlusive skin wrap in the delivery room for heat preservation in the LBW premature infant and propose a guideline for use.
In utero, the fetus is entirely dependent on the mother as a heat source and for heat removal. At birth, exposure to a colder extrauterine environment plays an important role in the physiologic processes that must occur for the infant to begin the homeothermic process of regulating its own heat. Prolonged exposure to the colder extrauterine environment without thermoprotective measures places the newly born infant at risk for further heat loss and ensuing hypothermia. The deleterious effects of hypothermia may result in increased oxygen and metabolic demands, acid-base derangements, respiratory compromise, hypoglycemia, and even death once the infant's compensatory mechanisms fail. Thermal protection of the newborn remains a global health concern and a challenge to health care providers despite advances in technology that provide warmth and minimize hypothermia after birth.
The World Health Organization classifies neonatal hypothermia as mild 36.0°C –36.4°C (96.8°F–97.5°F), moderate 32°C –35.9°C (89.6°F –96.6°F), and severe (<32°C/89.6°F). Hypothermia (<36.5 °C/97.7°F axillary) is a major factor in morbidity and mortality of low-birth-weight (LBW) premature infants. Laptook et al reported for every 1°C (1.7°F) decrease in admission temperature the odds of late onset sepsis was increased by 11% and the risk of death increased by 28%. Moderate and severe hypothermia was associated with a higher risk of grade 3–4 intraventricular hemorrhage (IVH) and death in LBW infants below 1500 grams.
Clinicians are challenged with maintaining a neutral-thermal environment for infants transitioning from in utero conditions to the delivery room environment. Evidence demonstrates that it is crucial to provide thermal protective strategies from the onset of birth in the delivery room for all infants, especially LBW premature infants. Conventional heat conservation strategies such as increasing ambient delivery room temperature (≥25°C/77°F), providing warmth, drying the infant with a warmed towel/blanket, applying a hat, and promoting skin-to-skin bonding with the mother are insufficient to prevent hypothermia for LBW premature infants. Utilization of an occlusive skin wrap in the delivery room as an adjunct intervention for thermo-conservation of LBW premature infants is advocated by the American Academy of Pediatrics (AAP) neonatal resuscitation program guidelines. However, for this population, the safety, efficacy and long-term effects of occlusive skin wrap use is limited. The purpose of this evidentiary review is to examine the evidence on occlusive skin wrap in LBW premature infants as an adjunct to conventional thermo-conservation interventions used in the delivery room. In addition, this review will propose an evidence-based guideline for the adjunctive use of occlusive skin wrap for the LBW premature infant population.
Abstract and Introduction
Abstract
Low-birth-weight (LBW) premature infants are born without the adaptive mechanisms needed for survival outside of the womb. These fragile infants require thermoprotective interventions that begin in the delivery room. Current heat preservation interventions such as a pre-warmed delivery room, warm blankets/towels, drying, radiant warmer tables, and skin-to-skin with mother are not as effective in preserving heat in the smallest of infants. Despite the use of current heat preservation strategies, LBW premature infants remain vulnerable to hypothermia and associated morbidities and mortality. The use of an occlusive skin wrap has been studied since the late 1960's as a method for heat loss prevention in infants at birth. This evidentiary review will explore the most recent research on occlusive skin wrap in the delivery room for heat preservation in the LBW premature infant and propose a guideline for use.
Introduction
In utero, the fetus is entirely dependent on the mother as a heat source and for heat removal. At birth, exposure to a colder extrauterine environment plays an important role in the physiologic processes that must occur for the infant to begin the homeothermic process of regulating its own heat. Prolonged exposure to the colder extrauterine environment without thermoprotective measures places the newly born infant at risk for further heat loss and ensuing hypothermia. The deleterious effects of hypothermia may result in increased oxygen and metabolic demands, acid-base derangements, respiratory compromise, hypoglycemia, and even death once the infant's compensatory mechanisms fail. Thermal protection of the newborn remains a global health concern and a challenge to health care providers despite advances in technology that provide warmth and minimize hypothermia after birth.
The World Health Organization classifies neonatal hypothermia as mild 36.0°C –36.4°C (96.8°F–97.5°F), moderate 32°C –35.9°C (89.6°F –96.6°F), and severe (<32°C/89.6°F). Hypothermia (<36.5 °C/97.7°F axillary) is a major factor in morbidity and mortality of low-birth-weight (LBW) premature infants. Laptook et al reported for every 1°C (1.7°F) decrease in admission temperature the odds of late onset sepsis was increased by 11% and the risk of death increased by 28%. Moderate and severe hypothermia was associated with a higher risk of grade 3–4 intraventricular hemorrhage (IVH) and death in LBW infants below 1500 grams.
Clinicians are challenged with maintaining a neutral-thermal environment for infants transitioning from in utero conditions to the delivery room environment. Evidence demonstrates that it is crucial to provide thermal protective strategies from the onset of birth in the delivery room for all infants, especially LBW premature infants. Conventional heat conservation strategies such as increasing ambient delivery room temperature (≥25°C/77°F), providing warmth, drying the infant with a warmed towel/blanket, applying a hat, and promoting skin-to-skin bonding with the mother are insufficient to prevent hypothermia for LBW premature infants. Utilization of an occlusive skin wrap in the delivery room as an adjunct intervention for thermo-conservation of LBW premature infants is advocated by the American Academy of Pediatrics (AAP) neonatal resuscitation program guidelines. However, for this population, the safety, efficacy and long-term effects of occlusive skin wrap use is limited. The purpose of this evidentiary review is to examine the evidence on occlusive skin wrap in LBW premature infants as an adjunct to conventional thermo-conservation interventions used in the delivery room. In addition, this review will propose an evidence-based guideline for the adjunctive use of occlusive skin wrap for the LBW premature infant population.
