Active warming after caesarean section to prevent neonatal hypothermia: a systematic review
There is a lack of evidence on the effects of perioperative warming on maternal and neonatal outcomes in women undergoing elective caesarean section who are performing at-birth skin-to-skin contact. This study aimed to provide a systematic review of the current evidence base on the effects of perioperative warming versus no warming. Inclusion criteria included randomised controlled trials involving pregnant women ≥18 years old undergoing an elective caesarean section at term under regional anaesthesia and who initiated at-birth neonatal skin-to-skin contact. Studies investigated active warming versus no active warming interventions. Three studies were included, with a total of 286 participants. Active warming of women resulted in significantly less occurrence of neonatal hypothermia, with no difference in maternal hypothermia. Perioperative active warming of mothers and newborns who had skin-to-skin contact may be beneficial. The quality of the included studies was low, so the review findings should be interpreted with caution. High quality studies with larger sample sizes need to be undertaken.
Skin-to-skin contact (SSC) has many benefits for the physical and emotional wellbeing of both newborns and their mothers (Boundy et al 2016; Moore et al, 2016;). Although SSC is a well-established practice following vaginal birth, it is not widely implemented during a caesarean section (CS) (Phillips, 2013). Among the reasons for not establishing perioperative SSC is the increased risk of mothers and newborns becoming hypothermic during a CS, which may act as a barrier to perioperative SSC as a result of maternal–newborn separation for warming of one or both parties (Mangan and Mosher, 2012).
Hypothermia during a CS may impact on the health of mothers and their newborns if no actions are taken to prevent their temperature reduction (Mank et al, 2016). Maternal hypothermia after a CS could cause shivering, delayed wound healing and increased risk of wound infection and haemorrhage (Melling et al, 2001), while neonatal hypothermia can lead to respiratory embarrassment, apnoea, hypoxaemia, carbon dioxide retention, metabolic acidosis, hypoglycaemia and decreased oxygen delivery to the tissues (Bajwa, 2014). Given its potential adverse effects, hypothermia should be prevented and diagnosed and managed promptly.
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