Abstract
OBJECTIVE:
To systematically identify and synthesize investigations of the effectiveness of occlusive skin wrap for reducing heat loss in premature infants born at less than 36 weeks gestations.
STUDY DESIGN:
Systematic review.
RESULTS:
Three randomized controlled trials (RCT) and five historical controlled trials (HCT) were included. Meta-analysis shows wrapped infants had significantly higher admission temperatures than unwrapped infants (RCTs WMD 0.63°C, 95% confidence interval (CI) 0.38, 0.87; HCTs WMD 0.96°C, 95% CI 0.66, 1.27). A statistically significant difference in mortality was not found between wrapped and unwrapped infants in the RCTs (RR 0.72, 95% CI 0.36, 1.45) or the HCTs (RR 0.76, 95% CI 0.51, 1.13).
CONCLUSIONS:
The findings suggest that occlusive skin wrap prevents heat loss in premature infants. The meta-analysis lacked the power to provide definitive results regarding the effect of wrap on mortality.
Similar content being viewed by others
References
Silverman WA, Fertig JW, Berger AP . The influence of the thermal environment upon the survival of newly born premature infants. Pediatrics 1958;21:876–885.
Johanson RB, Spencer SA, Rolfe P, Jones P, Malla DS . Effect of post-delivery care of neonatal body temperature. Acta Pediatr 1998;81:859–863.
Costeloe K, Hennessy F, Gibson AT, Marlow N, Wilkinson AR, for the EPICure Study Group. The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 2000;106:659–671.
Vohra V, Frent G, Campbell V, Abbott M, Whyte R . Effect of polyethylene occlusive skin wrapping on heat loss in very low birth weight infants at delivery: a randomized trial. J Pediatr 1999;134(5):547–551.
Beinder E, Trojean A, Bucher HU, Huch A, Huch R . Control of skin blood flow in pre- and full-term infants. Biol Neonate 1994;51:7–15.
Karlsson H, Olegard R, Nilsson K . Regional skin temperature, heat flow and conductance in preterm neonates nursed in low and neutral environmental temperature. Acta Paediatr 1996;85:81–87.
Chameides L, Hazinski MF . Pediatric Advanced Life Support. Dallas: American Heart Association; 1997.
Knobel R, Vohra S, Holditch-Davis D, Lehmann C . Network Survey of Heat Loss Prevention (HeLP) in the Delivery Room (paper presentation). Southern Research Nursing Society: International Nursing Research. 2004.
Knobel R, Wimmer J, Holbert D . Heat loss prevention for preterm infants in the delivery room. J Perinatol 2004;25:304–308.
Lenclen R, Mazraani M, Jugie M, et al. Reducinq heat loss in preterm infants at delivery with polyethylene bags. [French]. Arch Pediatr 2002;9(3):238–244.
Lyon AJ, Stenson B . Cold comfort for babies (Letter). Arch Dis Child 2004;89:F93–F94.
Meyer MP . Swaddling and Heat Loss (Letter). Arch Dis Child Fetal Neonatal Ed 2003;88:F256.
Newton T, Watkinson M . Preventing hypothermia at birth in preterm babies: at a cost of overheating some? (Letter). Arch Dis Child Fetal Neonatal Ed 2003;88:F256.
Bjorklund LJ . Reducing heat loss at birth in very preterm infants (Letter). J Pediatr 2000;137:739–740.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary. Control Clin Trials 1996;17(1):1–12.
Schulz KF, Chalmers I, Hayes RJ, Altman DG . Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trial. J Am Med Assoc 1995;273(5):408–412.
Guyatt G, Haynes B, Jaeschke R, et al. Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. Chicago: American Medical Association Press; 2002.
Pearson ES . The percentage limits for the distribution of range in samples from a normal population. Biometrika 1932;24:404–417.
The Cochrane Collaboration. Cochrane Reviewer's Handbook 4.2.2 [Web Page]. March 2004; Available at http://www.cochrane.dk/cochrane/handbook/hbook.htm(Accessed 16 June 2004).
Higgins JPT, Thompson SG, Deeks JJ, Altman DG . Measuring inconsistency in meta-analyses. BMJ 2003;327:557–560.
Vohra S, Roberts R, Zhang B, Janes M, Schmidt B . Heat loss prevention in the delivery room: a randomized clinical trial in very preterm infants. J Pediatr 2004;145:750–753.
Baumgart S . Reduction of oxygen consumption, insensible water loss, and radiant heat demand with use of a plastic blanket for low-birth-weight infants under radiant warmers. Pediatrics 1984;74(6):1022–1028.
Baumgart S, Fox WW, Polin RA . Physiologic implications of two different heat shields for infants under radiant warmers. J Pediatr 1982;100(5):787–790.
Baumgart S, Engle WD, Fox WW, Polin RA . Effect of heat shielding on convective and evaporative heat losses and on radiant heat transfer in the premature infant. J Pediatr 1981;99(6):948–956.
Walterspiel JN . Design and performance of blanket heat shields for neonates. Acta Paediatr Scand 1991;80(11):993–998.
Marks KH, Williams RK, Groff HC, Jeffrey M . The Micro-Environment of Premature-infants Under a Plexiglass Dome and Plastic Blanket. Pediatr Res 1981;15(4):671.
Brice JE, Rutter N . Reduction of skin water loss in the newborn. II. Clinical trial of two methods in very low birthweight babies. Arch Dis Child 1981;56(9):673–675.
Baumgart S . Radiant energy and insensible water loss in the premature newborn infant nursed under a radiant warmer. [Review] [62 refs]. Clin Perinatol 1982;9(3):483–503.
Behrman RE, Kleigman RM, Jenson HB . Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pennsylvania: W.B. Saunders Company; 2000.
World Health Organization. Thermal Protection of the Newborn: A Practical Guide. Geneva: Maternal and Newborn Health/Safe Motherhood Unit: Division of Reproductive Health World Health Organization; 2004.
Vermont Oxford Network. Vermont Oxford Network [Web Page]. Available at http://www.vtoxford.org/(Accessed 8 December 2004).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cramer, K., Wiebe, N., Hartling, L. et al. Heat Loss Prevention: A Systematic Review of Occlusive Skin Wrap for Premature Neonates. J Perinatol 25, 763–769 (2005). https://doi.org/10.1038/sj.jp.7211392
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jp.7211392
- Springer Nature America, Inc.
This article is cited by
-
Using polyethylene plastic bag to prevent moderate hypothermia during transport in very low birth weight infants: a randomized trial
Journal of Perinatology (2018)
-
Initial Management of the Extremely Low-Birth-Weight Infant
Current Treatment Options in Pediatrics (2017)
-
The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates
Journal of Perinatology (2016)
-
Delivery Room Quality Improvement Project Improved Compliance with Best Practices for a Community NICU
Scientific Reports (2016)
-
The Principle of Equipoise in Pediatric Drug Trials
Pediatric Drugs (2015)