hypothermia in children edit

8/2/2019 Hypothermia in Children Edit..

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General anesthesia: a comparison between

upper- and lower-body warming

1. AHMED A. SHORRAB,2. MOHAMED E. EL-SAWY,3. MAHMOUD M. OTHMAN,4. GOLINAR E. HAMMOUDA

DOI: 10.1111/j.1460-9592.2006.02006.xArticle first published online: 26 JUN 2006

Pediatric Anesthesia

Volume 17, Issue 1, pages 3843, January 2007

Summary

Background :

Children receiving combined epidural and general anesthesia may be at greater risk ofhypothermia. Active warming should be undertaken to combat heat loss. With combined epiduraland general anesthesia heat loss from the lower body may be greater than from the upper bodybecause of shift of blood towards the vasodilated lower body. We assumed that application of thewarming blanket to the lower body might provide better protection against hypothermia. To testthis hypothesis, lower-body warming (LBW) was compared with upper-body warming (UBW) in

a randomized comparative study.

Methods:

Children subjected to open urologic surgery under combined epidural and general anesthesiawere randomly allocated to either UBW n = 38 or LBW n = 35 using a forced-air warmingblanket. Core and peripheral skin temperatures were monitored. Temperature gradients between
http://onlinelibrary.wiley.com/doi/10.1111/pan.2007.17.issue-1/issuetochttp://onlinelibrary.wiley.com/doi/10.1111/pan.2007.17.issue-1/issuetoc


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forearm and fingertip during LBW and between leg and toe during UBW were calculated. Thewarmer was set at 32C, room temperature was around 22C and fluids were infused at ambientroom temperature.

Results :

The changes in core temperature were comparable and parallel in both groups. Core temperaturedecreased significantly in each group at 1 h after induction compared with basal values.Temperature gradients at forearm-fingertip and at leg-toe were also comparable in both groups.Recovery was uneventful and no patient shivered in the recovery room.

Conclusions :

Lower body warming is as effective as UBW in prevention of hypothermia in children subjectedto combined epidural and general anesthesia.

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Use of plastic bags to prevent hypothermia at

birth in preterm infants-do they work at

lower gestations?1. CPH Ibrahim,2. CW Yoxall

Article first published online: 21 OCT 2008DOI: 10.1111/j.1651-2227.2008.01076.x

2008 The Author(s)/Journal Compilation 2008 Foundation Acta Pdiatrica/Acta PdiatricaIssue

Acta Paediatrica

Volume 98, Issue 2, pages 256260, February 2009

Abstract

Background:

Hypothermia at birth is strongly associated with mortality and morbidity in preterm infants.Occlusive wrapping of preterm infants during resuscitation, including polythene bags have beenshown to prevent hypothermia.

Objectives :

To evaluate the effectiveness of the introduction of polythene bags at resuscitation of infantsborn below 30 weeks gestation in a large tertiary neonatal centre.
http://onlinelibrary.wiley.com/doi/10.1111/apa.2009.98.issue-2/issuetochttp://onlinelibrary.wiley.com/doi/10.1111/apa.2009.98.issue-2/issuetoc


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Methods :

Retrospective audit of admission temperatures of all infants born below 30 weeks gestation fortwo years before and two years after the introduction of polythene bags. Hypothermia wasdefined as admission axillary temperature < 36C.

Results :

A total of 334 eligible infants were born during the study period. Two hundred and fifty-three(75.8%) had admission temperatures recorded. The incidence of hypothermia fell from 25% to16%(p = 0.098) for the whole group since the introduction of polythene bags. The mainreduction in hypothermia was seen in infants born above 28 weeks gestation (19.4% vs. 3.9%, p= 0.017). There was no significant effect in infants born between 28 weeks and 30 weeks (29.3%vs. 24.8%, p = 0.58).

Conclusions :

Polythene bags are effective in reducing the incidence of hypothermia at admission in infantsborn below 30 weeks gestation. The benefit in infants born below 28 weeks gestation was onlymarginal. This is in contrast to previously published studies. This may be related to thecomparatively low incidence of hypothermia at the study centre even prior to introduction ofpolythene bags.


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Warming preterm infants in the delivery

room: polyethylene bags, exothermic

mattresses or both?1. Lisa K McCarthy1,2,3,2. Colm PF ODonnell1,2,3

Article first published online: 4 OCT 2011DOI: 10.1111/j.1651-2227.2011.02375.x 2011 The Author(s)/Acta Pdiatrica 2011 Foundation Acta PdiatricaIssue

Acta Paediatrica

Volume 100, Issue 12, pages 15341537, December 2011

Keywords:

Exothermic mattress; Hypothermia; Infant; Polyethylene bag; Premature

Abstract

Aims :

To compare the admission temperature of infants treated with polyethylene bags alone to infantstreated with exothermic mattresses in addition to bags in the delivery room.
http://onlinelibrary.wiley.com/doi/10.1111/apa.2011.100.issue-12/issuetochttp://onlinelibrary.wiley.com/doi/10.1111/apa.2011.100.issue-12/issuetoc


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Methods :

We prospectively studied infants born at


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Interventions to prevent hypothermia at

birth in preterm and/or low birthweight

infants1. Emma M McCall1,*,2. Fiona Alderdice2,3. Henry L Halliday3,4. John G Jenkins4,5. Sunita Vohra5

Editorial Group: Cochrane Neonatal Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 12 SEP 2007DOI: 10.1002/14651858.CD004210.pub3Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Abstract

Background

Hypothermia incurred during routine postnatal resuscitation is a world-wide issue (across allclimates), associated with morbidity and mortality. Keeping vulnerable preterm infants warm isproblematic even when recommended routine thermal care guidelines are followed in thedelivery suite.

Objectives

To assess efficacy and safety of interventions designed for prevention of hypothermia in pretermand/or low birthweight infants applied within ten minutes after birth in the delivery suite

compared with routine thermal care.

Search strategy

The standard search strategy of The Cochrane Collaboration was followed. Electronic databaseswere searched: MEDLINE (1966 to July Week 4 2007 ), CINAHL (1982 to July Week 4 2007),EMBASE (1974 to 01/08/2007), the Cochrane Central Register of Controlled Trials
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(CENTRAL, The Cochrane Library, Issue 3, 2007), Database of Abstracts of Reviews of Effects(DARE 1994 to July 2007), conference/symposia proceedings using ZETOC (1993 to17/08/2007), ISI proceedings (1990 to 17/08/2007) and OCLC WorldCat (July 2007). Identifiedarticles were cross-referenced. No language restrictions were imposed.

Selection criteria

All trials using randomised or quasi-randomised allocations to test a specific interventiondesigned to prevent hypothermia, (apart from 'routine' thermal care) applied within 10 minutesafter birth in the delivery suite to infants of < 37 weeks' gestational age or birthweight 2500 g.

Data collection and analysis

Methodological quality was assessed and data were extracted for important clinical outcomesincluding adverse effects of the intervention by at least three independent review authors.

Authors were contacted for missing data. Data were analysed using RevMan 4.2.5. Relative risk(RR), risk difference (RD) and number needed to treat (NNT) with 95% confidence limits werecalculated for each dichotomous outcome and mean differences (MD) with 95% confidencelimits for continuous outcomes.

Main results

Six studies giving a total of 304 infants randomised and 295 completing the studies wereincluded. Four comparisons to 'routine care' were undertaken within two categories:1) barriers to heat loss (four studies): plastic wrap or bag (three), stockinet caps (one) and2) external heat sources (two studies): skin-to-skin (one), transwarmer mattress (one).

Plastic barriers were effective in reducing heat losses in infants < 28 weeks' gestation (threestudies, n = 159; WMD 0.76 C; 95% CI 0.49, 1.03), but not in infants between 28 to 31 week'sgestation. There was insufficient evidence to suggest that plastic wrap reduces the risk of deathwithin hospital stay (three studies, n = 161; typical RR 0.63; 95% CI 0.32, 1.22; typical RD -0.09; 95% CI -0.20, 0.03). There was no evidence of a significant difference in major braininjury, mean duration of oxygen therapy or hospitalisation for infants < 29 weeks' gestation.Stockinet caps were not effective (borderline significant for infants < 2000 g birthweight) in

reducing heat losses.

Skin-to-skin care was shown to be effective in reducing the risk of hypothermia when comparedto conventional incubator care for infants 1200 to 2199 g birthweight (one study, n = 31; RR0.09; 95% CI 0.01, 0.64; NNT 2; 2 to 4). The transwarmer mattress kept infants 1500 g

significantly warmer and reduced the incidence of hypothermia on admission to NICU(one study, n = 24; RR 0.30; 95% CI 0.11, 0.83; NNT 2 range 2 to 4).


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Authors' conclusions

Plastic wraps or bags, skin-to-skin care and transwarmer mattresses all keep preterm infantswarmer, leading to higher temperatures on admission to neonatal units and less hypothermia.Given the low NNT, consideration should be given to using these interventions in the delivery

suite. However, the small numbers of infants and studies and the absence of long-term follow-upmean that firm recommendations for clinical practice cannot be given. There is a need to conductlarge, high quality randomised controlled trials looking at long-term outcomes.


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Heat Loss Prevention in Very Preterm Infants in Delivery

Rooms: A Prospective, Randomized, Controlled Trial of

Polyethylene Caps

The Journal of Pediatrics

Volume 156, Issue 6

Pages 914-917.e1

Daniele Trevisanuto, Nicoletta Doglioni, Francesco Cavallin, Matteo Parotto, MassimoMicaglio, Vincenzo Zanardo

Abstract

Objective

To evaluate in preterm infants whether polyethylene caps prevent heat loss after delivery betterthan polyethylene occlusive wrapping and conventional drying.

Study design

This was a prospective, randomized, controlled trial of infants


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Conclusions

For very preterm infants, polyethylene caps are comparable with polyethylene occlusive skinwrapping to prevent heat loss after delivery. Both these methods are more effective thanconventional treatment.

Copyright 2009 Elsevier B.V. All rights reserved.

http://linkinghub.elsevier.com/retrieve/pii/S0022347609012505?via=sd&cc=y
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Original Article

Journal of Perinatology (2005) 25, 304308. doi:10.1038/sj.jp.7211289

Heat Loss Prevention for Preterm Infants in the Delivery

Room

This research was partially supported by National Institute for Nursing Research T32 NR07091Interventions to Prevent and Manage Chronic Illness.

Robin B Knobel RNC, MSN, NNP1, John E Wimmer Jr MD2and Don Holbert PhD3

1. 1Children's Hospital (R.B.K.), University Health Systems of Eastern Carolina and University ofNorth Carolina, Chapel Hill, USA

2. 2Neonatal Medicine (J.E.W.), Women's Hospital of Greensboro, Greensboro, NC, USA3. 3Department of Biostatistics (D.H.), School of Allied Health Sciences, East Carolina University,

USA.

Correspondence : John E Wimmer Jr., MD, Neonatal Medicine, Women's Hospital ofGreensboro, 801 Green Valley Rd, Greensboro NC 27408, USA.

Abstract

OBJECTIVE:Preterm infants are prone to hypothermia immediately following birth. Among other factors,excessive evaporative heat loss and the relatively cool ambient temperature of the delivery roommay be important contributors. Most infants


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RESULTS:

Intervention patients were less likely than control patients to have temperature < 36.4C onadmission , 44 vs 70% (p


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Randomized controlled trial of skin-to-skin

contact from birth versus conventional

incubator for physiological stabilization in1200- to 2199-gram newborns

1. NJ Bergman1,*,2. LL Linley1,2,3. SR Fawcus1,3

Article first published online: 2 JAN 2007DOI: 10.1111/j.1651-2227.2004.tb03018.

Keywords:

Hypothermia; prematurity; separation; skin-to-skin contact; stability

Aim :

Conventional care of prematurely born infants involves extended maternal-infant separation andincubator care. Recent research has shown that separation causes adverse effects. Maternal-infantskin-to-skin contact (SSC) provides an alternative habitat to the incubator, with proven benefitsfor stable prematures; this has not been established for unstable or newborn low-birthweightinfants. SSC from birth was therefore compared to incubator care for infants between 1200 and2199 g at birth.

Methods :

This was a prospective, unblinded, randomized controlled clinical trial; potential subjects wereidentified before delivery and randomized by computerized minimization technique at 5 min ifeligible. Standardized care and observations were maintained for 6 h. Stability was measured interms of a set of pre-determined physiological parameters, and a composite cardio-respiratorystabilization score (SCRIP).


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Results :

34 infants were analysed in comparable groups: 3/18 SSC compared to 12/13 incubator babiesexceeded the pre-determined parameters (p < 0.001). Stabilization scores were 77.11 for SSCversus 74.23 for incubator (maximum 78), mean difference 2.88 (95% CI: 0.35.46, p = 0.031).

All 18 SSC subjects were stable in the sixth hour, compared to 6/13 incubator infants. Eight outof 13 incubator subjects experienced hypothermia.

Conclusion :

Newborn care provided by skin-to-skin contact on the mother's chest results in betterphysiological outcomes and stability than the same care provided in closed servo-controlledincubators. The cardio-respiratory instability seen in separated infants in the first 6 h is consistentwith mammalian protest-despair biology, and with hyper-arousal and dissociation responsepatterns described in human infants: newborns should not be separated from their mothers.

onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2004.tb03018.x/abstract


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Kangaroo mother care for low birthweight

infants: a randomized controlled trial in

different settings1. A Cattaneo1,*,2. R Davanzo1,3. B Worku2,4. A Surjono3,5. M Echeverria4,6. A Bedri2,7. E Haksari3,8.

L Osorno

4

,9. B Gudetta2,10.D Setyowireni3,11.S Quintero1,12.G Tamburlini1

Article first published online: 2 JAN 2007DOI: 10.1111/j.1651-2227.1998.tb01769.x

Keywords:

Developing countries; kangaroo mother care; low birthweight infants

A randomized controlled trial was carried out for 1 y in three tertiary and teaching hospitals, inAddis Ababa (Ethiopia), Yogyakarta (Indonesia) and Merida (Mexico), to study theeffectiveness, feasibility, acceptability and cost of kangaroo mother care (KMC) when comparedto conventional methods of care (CMC). About 29% of 649 low birthweight infants (LBWI;1000-1999 g) died before eligibility. Of the survivors, 38% were excluded for various reasons,

149 were randomly assigned to KMC (almost exclusive skin-to-skin care after stabilization), and136 to CMC (warm room or incubator care). There were three deaths in each group and nodifference in the incidence of severe disease. Hypothermia was significantly less common inKMC infants in Merida (13.5 vs 31.5 episodes/100 infants/d) and overall (10.8 vs 14.6).Exclusive breastfeeding at discharge was more common in KMC infants in Merida (80% vs16%) and overall (88% vs 70%). KMC infants had a higher mean daily weight gain (21.3 g vs17.7 g) and were discharged earlier (13.4 vs 16.3 d after enrolment). KMC was considered


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feasible and presented advantages over CMC in terms of maintenance of equipment. Mothersexpressed a clear preference for KMC and health workers found it safe and convenient. KMCwas cheaper than CMC in terms of salaries (US$ 11 788 vs US$ 29 888) and other running costs(US$ 7501 vs US$ 9876). This study confirms that hospital KMC for stabilized LBWI 1000-1999 g is at least as effective and safe as CMC, and shows that it is feasible in different settings,

acceptable to mothers of different cultures, and less expensive. Where exclusive breastfeeding isuncommon among LBWI, KMC may bring about an increase in its prevalence and duration, withconsequent benefits for health and growth. For hospitals in low-income countries KMC mayrepresent an appropriate use of scarce resources.

http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.1998.tb01769.x/abstract
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Original Article

Experience with Kangaroo mother care in aneonatal intensive care unit (NICU) in

Chandigarh, India

Veena Rani Parmar, Ajay Kumar, Rupinder Kaur, Siddharth Parmar, D. Kaur, Srikant Basu,Suksham Jain and Sunny Narula

Abstract

Objective

To study the feasibility and acceptability of Kangaroo mother care (KMC) on the low birthweight infants (LBWI) in the neonatal intensive care unit (NICU) by the mothers, familymembers and health care workers (HCW) and to observe its effect on the vital parameters of thebabies.

Method

A observation in the NICU.

Results

A total of 135 babies (74 boys and 61 girls) who completed minimum of 4 hrs of KMC/day,were included. The mean birth weight and gestation were 1460gm and 30 week respectively.47% babies started KMC within first week of age. Mean duration of KMC was 7 days (348)days. The O2 saturation improved by 23%, temperature (C) rose from 36.75 0.19 to 37.23 0.25, respiration stabilized (p


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Conclusion

KMC was found to be safe, effective and feasible method of care of LBWI even in the NICU

settings. Positive attitudes were observed in mothers, families and HCW

http://www.springerlink.com/content/k031777349l34381/


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A comparison of kangaroo mother care and

conventional incubator care for thermalregulation of infants < 2000 g in Nigeria using

continuous ambulatory temperature

monitoring

Authors : Ibe, O.E.1; Austin, T.2; Sullivan, K.3; Fabanwo, O.2; Disu, E.2; Costello, A.M. de L.3

Source : Annals of Tropical Paediatrics: International Child Health, Volume 24, Number 3,September 2004 , pp. 245-251(7)

Publisher :Maney PublishingPublication date : 2004-09-01DOI : http://dx.doi.org/10.1179/027249304225019082Document Type : Research Article

Abstract:

Although skin-to-skin contact (or kangaroo mother care, KMC) for preterm infants is a practicalalternative to incubator care, no studies have compared these methods using continuousambulatory temperature monitoring. To compare thermal regulation in low birthweight infants ( 90% when nursed by KMC rather than conventional care, relative risk (RR) 0.09(0.030.25). More cases of hyperthermia (> 37.5C) occurred with KMC, and coreperipherytemperature differences were widened, but the risk of hyperthermia > 37.9C (RR 1.3, 0.91.7)was not significant. Micro-ambient temperatures were higher during KMC, although the averageroom temperatures during both procedures did not differ significantly. Mothers felt that KMCwas safe, and preferred the method to CC because it did not separate them from their infants,
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although some had problems adjusting to this method of care. Where equipment for thermalregulation is lacking or unreliable, KMC is a preferable method for managing stable lowbirthweight infants.

Affiliations:1: POLICY Project, Abuja, Nigeria 2: Lagos State University Teaching Hospital,

Ikeja, Lagos, Nigeria 3: International Perinatal Care Unit, Institute of Child Health, UniversityCollege London, UK

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hypothermia in children edit

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