Ramaswamy V V, Dawson J A, de Almeida M F, Trevisanuto D, Nakwa F L, Kamlin C O F, Trang J, Wyckoff M H, Weiner G M, Liley H G
Ankura Hospital for Women and Children, Hyderabad, India.
Newborn Research Centre, The Royal Women's Hospital, Victoria, Australia.
Resuscitation. 2023 Oct;191:109934. doi: 10.1016/j.resuscitation.2023.109934. Epub 2023 Aug 18.
To evaluate delivery room (DR) interventions to prevent hypothermia and improve outcomes in preterm newborn infants <34 weeks' gestation.
Medline, Embase, CINAHL and CENTRAL were searched till 22nd July 2022. Randomized controlled trials (RCTs), non-RCTs and quality improvement studies were considered. A random effects meta-analysis was performed, and the certainty of evidence was evaluated using GRADE guidelines.
DR temperature of ≥23 °C compared to standard care improved temperature outcomes without an increased risk of hyperthermia (low certainty), whereas radiant warmer in servo mode compared to manual mode decreased mean body temperature (MBT) (moderate certainty). Use of a plastic bag or wrap (PBW) improved normothermia (low certainty), but with an increased risk of hyperthermia (moderate certainty). Plastic cap improved normothermia (moderate certainty) and when combined with PBW improved MBT (low certainty). Use of a cloth cap decreased moderate hypothermia (low certainty). Though thermal mattress (TM) improved MBT, it increased risk of hyperthermia (low certainty). Heated-humidified gases (HHG) for resuscitation decreased the risk of moderate hypothermia and severe intraventricular hemorrhage (very low to low certainty). None of the interventions was shown to improve survival, but sample sizes were insufficient.
DR temperature of ≥23 °C, radiant warmer in manual mode, use of a PBW and a head covering is suggested for preterm newborn infants <34 weeks' gestation. HHG and TM could be considered in addition to PBW provided resources allow, in settings where hypothermia incidence is high. Careful monitoring to avoid hyperthermia is needed.
评估产房（DR）干预措施对预防孕龄<34周的早产新生儿体温过低并改善其预后的效果。
检索截至2022年7月22日的Medline、Embase、CINAHL和CENTRAL数据库。纳入随机对照试验（RCT）、非RCT和质量改进研究。进行随机效应荟萃分析，并使用GRADE指南评估证据的确定性。
与标准护理相比，产房温度≥23°C可改善体温结局，且不会增加体温过高的风险（证据确定性低），而与手动模式相比，伺服模式下的辐射保暖台会降低平均体温（MBT）（证据确定性中等）。使用塑料袋或包裹物（PBW）可改善体温正常情况（证据确定性低），但会增加体温过高的风险（证据确定性中等）。塑料帽可改善体温正常情况（证据确定性中等），与PBW联合使用时可改善MBT（证据确定性低）。使用布帽可降低中度体温过低的发生率（证据确定性低）。虽然热床垫（TM）可改善MBT，但会增加体温过高的风险（证据确定性低）。用于复苏的加热湿化气体（HHG）可降低中度体温过低和重度脑室内出血的风险（证据确定性从极低到低）。没有干预措施显示可提高生存率，但样本量不足。
建议对孕龄<34周的早产新生儿采用产房温度≥23°C、手动模式的辐射保暖台、使用PBW和头部覆盖物。在体温过低发生率高且资源允许的情况下，除PBW外，还可考虑使用HHG和TM。需要仔细监测以避免体温过高。
