Maintaining normal temperature immediately after birth in late preterm and term infants: A systematic review and meta-analysis



      Prevention of hypothermia after birth is a global problem in late preterm and term neonates. The aim of this systematic review and meta-analysis was to evaluate delivery room strategies to maintain normothermia and improve survival in late preterm and term neonates (≥34 weeks’ gestation).


      Medline, Embase, CINAHL, CENTRAL and international clinical trial registries were searched. Randomized controlled trials (RCTs), quasi-RCTs and observational studies were eligible for inclusion. Risk of bias for each study and GRADE certainty of evidence for each outcome were assessed.


      25 RCTs and 10 non-RCTs were included. Room temperature of 23 °C compared to 20 °C improved normothermia [Risk Ratio (RR), 95% Confidence Interval (CI): 1.26, 1.11–1.42)] and body temperature [Mean Difference (MD), 95% CI: 0.30 °C, 0.23–0.37 °C), and decreased moderate hypothermia (RR, 95% CI: 0.26, 0.16–0.42). Skin to skin care (SSC) compared to no SSC increased body temperature (MD, 95% CI: 0.32, 0.10–0.52), reduced hypoglycemia (RR, 95% CI: 0.16, 0.05–0.53) and hospital admission (RR, 95% CI: 0.34, 0.14–0.83). Though plastic bag or wrap (PBW) alone or when combined with SSC compared to SSC alone improved temperatures, the risk–benefit balance is uncertain. Clinical benefit or harm could not be excluded for the primary outcome of survival for any of the interventions. Certainty of evidence was low to very low for all outcomes.


      Room temperature of 23 °C and SSC soon after birth may prevent hypothermia in late preterm and term neonates. Though PBW may be an effective adjunct intervention, the risk–benefit balance needs further investigation.



      CI (Confidence interval), CoE (Certainty of evidence), GA (Gestational age), GRADE (Grading of Recommendations, Assessment, Development and Evaluations), ILCOR (International Liaison Committee on Resuscitation), MD (Mean difference), NICU (Neonatal intensive care unit), SSC (Skin-to-skin care), ROBINS-I (Risk Of Bias In Non-Randomised Studies of Interventions), TM (Thermal Mattress), RCT (Randomised controlled trial), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), QI (Quality improvement), PBW (Plastic bag or wrap), KMC (Kangaroo mother care)
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