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Perioperative active warming for preventing neonatal hypothermia: the Neohyp trial

02 August 2022
12 min read
Volume 30 · Issue 8

Abstract

Background

Perioperative hypothermia for women undergoing elective caesarean section is a common comorbidity, which may result in neonatal hypothermia when at-birth skin-to-skin contact is performed. This trial compared the effectiveness of warm intravenous and room temperature fluids among women performing at birth skin-to-skin contact on perioperative neonatal and maternal heat loss.

Methods

A double-blind, randomised controlled trial compared warm and room temperature intravenous fluids in 150 healthy women performing at birth skin-to-skin contact while undergoing elective caesarean section. Analysis was based on intention-to-treat.

Results

Active warming of women significantly reduced neonatal (P=0.02) and maternal (P=0.0027) hypothermia at the end of skin-to-skin contact in the operative theatre, maternal hypothermia on post-anaesthesia care unit admission (P=0.0022) and maternal shivering (P=0.0001).

Conclusions

Administering warm intravenous fluids during caesarean section when skin-to-skin contact is performed at birth is a safe practice with multiple health benefits for both newborns and their mothers. Consideration should be given to incorporating this intervention into clinical practice procedures promoting skin-to-skin contact in women undergoing elective caesarean section.

Initiation of at-birth skin-to-skin contact and early breastfeeding is a well-established practice after vaginal birth (Moore et al, 2016). Over recent years, this practice is increasingly being implemented during caesarean section birth (Phillips, 2013). As a result of the increased frequency of maternal and neonatal hypothermia during caesarean section, this patient population are at an increased risk of health complications associated with hypothermia (Sultan et al, 2015). There is also a higher chance of maternal/newborn separation because of the need to manage postoperative hypothermia (Vilinsky and McCaul, 2017). Preventing perioperative neonatal and maternal hypothermia is key not only in supporting the mother–newborn dyad but also in promoting early and longer duration of skin-to-skin contact and breastfeeding during and after caesarean section (Vilinsky et al, 2016). The use of perioperative warm intravenous fluids is a well-established practice used in the prevention of inadvertent perioperative hypothermia in the general population undergoing an operation (Munday et al, 2014; Sultan et al, 2015). However, a systematic review found that it was not widely researched in pregnant women undergoing caesarean section while performing at-birth skin-to-skin contact, highlighting the need for more robust randomised controlled trials (Vilinsky-Redmond et al, 2020).

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