RESUMEN
OBJECTIVE: To evaluate in preterm infants whether polyethylene caps prevent heat loss after delivery better than polyethylene occlusive wrapping and conventional drying. STUDY DESIGN: This was a prospective, randomized, controlled trial of infants <29 weeks' gestation including 3 study groups: (1) experimental group in which the heads of patients were covered with a polyethylene cap; (2) polyethylene occlusive skin wrap group; and (3) control group in which infants were dried. Axillary temperatures were compared at the time of admission to the neonatal intensive care unit (NICU) immediately after cap and wrap removal and 1 hour later. RESULTS: The 96 infants randomly assigned (32 covered with caps, 32 wrapped, 32 control) completed the study. Mean axillary temperature on NICU admission was similar in the cap group (36.1 degrees C +/- 0.8 degrees C) and wrap group (35.8 degrees C +/- 0.9 degrees C), and temperatures on admission to the NICU were significantly higher than in the control group (35.3 degrees C +/- 0.8 degrees C; P < .01). Infants covered with polyethylene caps (43%) and placed in polyethylene bags (62%) were less likely to have a temperature <36.4 degrees C on admission to the NICU than control infants (90%). In the cap group, temperature 1 hour after admission was significantly higher than in the control group. CONCLUSIONS: For very preterm infants, polyethylene caps are comparable with polyethylene occlusive skin wrapping to prevent heat loss after delivery. Both these methods are more effective than conventional treatment.
Asunto(s)
Regulación de la Temperatura Corporal , Hipotermia/prevención & control , Recien Nacido Prematuro/fisiología , Apósitos Oclusivos , Axila/fisiología , Temperatura Corporal , Regulación de la Temperatura Corporal/fisiología , Salas de Parto , Humanos , Cuidado del Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Polietilenos/uso terapéutico , Estudios ProspectivosAsunto(s)
Conducto Arterioso Permeable/fisiopatología , Endotelina-1/orina , Recien Nacido Prematuro/metabolismo , Vasopresinas/orina , Antiinflamatorios no Esteroideos/farmacología , Antiinflamatorios no Esteroideos/uso terapéutico , Presión Sanguínea , Conducto Arterioso Permeable/tratamiento farmacológico , Conducto Arterioso Permeable/metabolismo , Hemodinámica , Humanos , Recién Nacido , LigaduraAsunto(s)
Presión Sanguínea , Proteína C-Reactiva/metabolismo , Recién Nacido Pequeño para la Edad Gestacional/fisiología , Biomarcadores/sangre , Peso al Nacer , Niño , Retardo del Crecimiento Fetal/fisiopatología , Humanos , Recién Nacido , Recien Nacido Prematuro , Recién Nacido Pequeño para la Edad Gestacional/sangreRESUMEN
OBJECTIVE: To determine whether the timing of elective cesarean delivery at term influences the risk of neonatal pneumothorax. STUDY DESIGN: Chart reviews confirmed gestational age, delivery modalities, and diagnosis of pneumothorax of 66,961 term infants delivered in the Veneto region of northern Italy. Of these neonates, 17,783 (26.5%) were delivered by cesarean section, including 9988 elective (56.1%) and 7795 emergency (43.8%). RESULTS: In 5498 (55.0%) of neonates, an elective cesarean section was performed before 39 completed weeks. Fifty-nine neonates had pneumothorax diagnosed (0.88/1000 births). Neonates delivered by elective cesarean section had an increased incidence of pneumothorax (2.90/1000 births), in comparison with neonates delivered by emergency cesarean (1.53/1000 births; OR 4.21; 95% CI 2.02-8.74) or vaginally delivered (0.39/1000 births; OR 7.95; 95% CI 4.41-14.32). In elective cesarean sections there was a significant progressive reduction in the incidence of pneumothorax from week 37 0/7 to 37 6/7 onward (P < .01). CONCLUSIONS: The timing of elective cesarean section influences the pneumothorax risk. A reduction in neonatal iatrogenic pneumothorax would result if elective deliveries were performed after the 39 completed weeks of pregnancy.