Drying prior to plastic wrapping may not provide thermoregulatory benefits in infants admitted to the neonatal intensive care unit

1. Drying before plastic wrapping did not benefit very preterm infants in maintaining normothermia at admission to the neonatal intensive care unit.

Evidence Rating Level: 1 (Excellent)

Hypothermia at birth is linked with adverse neonatal outcomes. Despite the existence of interventions to prevent thermal loss at birth in very preterm infants, the incidence of hypothermia among this population at admission to the neonatal intensive care unit (NICU) remains high. Very preterm infants are commonly put in plastic wrap immediately at birth without drying to prevent heat loss. For infants of gestational age >32 weeks, drying has been recommended for thermal management. The potential advantages of combining drying and wrapping have not been explored for very preterm infants, who are at higher risk of heat loss due to evaporation. This study thus examined whether drying before plastic wrapping improves thermoregulation of very preterm infants at birth. This multicenter randomized clinical trial was conducted at 21 hospitals in Italy between February 21, 2023, and July 18, 2024, and included very preterm infants (birth weight <1500 g and/or gestational age ≤30 weeks 6 days). Neonates were randomly assigned 1:1 to either drying before plastic wrapping in the delivery room (intervention arm) or plastic wrapping without drying (control arm). The primary outcome was the proportion of infants within the normal thermal range (normothermia; 36.5-37.5 °C) at admission to the NICU. In total, 354 very preterm infants were randomized and included in the analysis (180 females [50.8%]; mean [SD] gestational age, 28.6 [2.5] weeks), with 177 in the intervention arm and 177 in the control arm. The proportion of neonates with normothermia was not significantly different between those dried vs undried (45.8% (81/177) vs 46.3% (82/177); risk ratio [RR], 0.99; 95% CI, 0.79-1.24). Dried neonates experienced a higher rate of in-hospital mortality compared to undried neonates (14.7% [26/177] vs 5.6% [10/177]; unadjusted risk ratio, 2.60; 95% CI, 1.29-5.23). Overall, this study found that drying before plastic wrapping did not benefit very preterm infants in maintaining normothermia at NICU admission. These results do not support drying before wrapping in the thermal management of this population. 

Click here to read this study in JAMA Network Open

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