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NICU guideline identifier

Hypothermia prevention in infants less than 30 weeks gestation

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This guideline applies to infants born at <30 weeks gestation at National Women's Health in either delivery unit or theatre and - if practical - elsewhere in Auckland City Hospital (e.g. antenatal wards, WAU or ED)

Introduction

  • Hypothermia in the premature newborn is associated with increased mortality and morbidity.1  
  • In infants <1500g, temperatures on admission to the neonatal unit are on average <35.5°C. 
  • Polyethylene wraps have been shown to be an effective intervention in improving core temperature on admission to neonatal units.2 

When and how to apply

  • Plastic wrap should be pre-warmed.
  • Note that the infant is not dried prior to being placed in the wrap.

See the images opposite for visual instructions

  • A SaO2 probe should be applied to the right arm/hand as soon as possible following delivery via the bottom of the wrapped infant. 
  • Vitamin K should be given in the Newborn Unit. (Note this should be prescribed on the stat dose side of the drug sheet). 
  • Temperature should be taken immediately on arrival in the NICU and again at 1 hour.

In the Operating Theatre

In theatre the infant is transferred to the radiant warmer and placed on a plastic wrap that has been pre-warmed. See image opposite Plastic wrap theatre

In Delivery Unit

  • In the Delivery Unit the infant is wrapped in warmed plastic wrap directly at mother's bedside in the same manner as outlined above. 
  • The infant is then transferred to the radiant warmer for immediate management. 

When CPAP is required

  • If CPAP is required the baby's head should be dried and CPAP bonnet applied in the usual way keeping the baby's body wrapped in plastic. 

When to remove wrap

  • When the infant is stabilised in the neonatal unit in either a humidified incubator or heat table the plastic can be removed. 
  • Drying the infant is not necessary. 
  • Admission temperature and temperature at 1 hour should be recorded and care must be taken not to overheat the infant. 

References

  1. Costeloe K, Hennessy E, Gibson A, Marlow N, Wilkinson A. The EPICure Study: Outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 2000;106(4):659 
  2. 2 McCall EM, Alderdice F, Halliday HL, Jenkins JG, Vohra S. Interventions top prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane Database of Systematic Reviews 2010, Issue3. Art. No. DOI:10.1002/14651858.CD004210.pub4..

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Document Control

  • Date last published: 30 April 2015
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years