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Neonatology

Poster Session 4

(1106) Preventing Hypothermia in Moderate and Late Preterm Neonates: A delivery room randomized controlled pilot trial

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Neonatal hypothermia (< 36.5C) at admission has been associated with an increased risk of morbidity and mortality. This study evaluated the safety and efficacy of warming moderate and late preterm neonates delivered via cesarean during delayed umbilical cord clamping (dUCC).

Study Design: Parallel group randomized controlled pilot trial with block randomization stratified for two gestational age groups--32w0d-34w6d and 35w0d-36w6d. The control and intervention groups underwent dUCC for 60 seconds at the time of cesarean; if considered safe by both pediatric and obstetric providers. Neonates in the intervention group were placed in a polyethylene suit above a chemical warming mattress during the dUCC period. The devices were removed at the resuscitation warmer. Axillary temperature was measured at arrival to the warmer, completion of resuscitation and arrival to the neonate's room. All providers were trained using a standardized video.

Results: 52 patients were randomized, 26 to each group and two were excluded prior to delivery. Modified Poisson regression, adjusting for stratum and time from delivery to the warmer, demonstrated no difference in the risk of hypothermia at the warmer, RR 2.71 (95% CI 0.70-10.51). Of note, RR of hypothermia at arrival to the neonate’s room was 0.60 (95% CI 0.28-1.29) and NICU admission was 0.81 (95% CI 0.64-1.02). The effect was mostly attributed to a lower risk of moderate hypothermia (< 36.0C) at arrival to neonate's room, RR 0.24 (95% CI 0.03-1.92). Other secondary outcomes including hypoglycemia, highest bilirubin level, form of respiratory support, pulmonary hemorrhage, hyperthermia ( >37.5C), length of stay, and neonatal composite (outcomes of death, intraventricular hemorrhage and/or sepsis) did not reach significance and had wide confidence intervals.

Conclusion: While there was no difference in temperature at the warmer or safety signals, there may be an improvement in admission hypothermia and NICU admissions. These pilot results will inform the design of a well-powered multi-center trial for hypothermia prevention.