# Drying Very Preterm Infants Before Plastic Wrapping at Birth: A Randomized Clinical Trial

## TL;DR

A study on very preterm infants found that drying them before wrapping in plastic at birth does not help maintain normal body temperature better than wrapping alone.

## Contribution

This study is the first to show that adding drying to plastic wrapping does not improve thermal management in very preterm infants.

## Key findings

- Drying before plastic wrapping did not improve normothermia rates at NICU admission.
- Mortality was higher in the dried group, though likely due to neonatal health rather than the intervention.
- Approximately half of the infants were outside the normal thermal range at NICU admission.

## Abstract

Does drying before plastic wrapping improve thermoregulation of very preterm infants at birth?

This multicenter randomized clinical trial including 354 very preterm infants found that drying before plastic wrapping provided no benefit in maintaining normothermia at neonatal intensive care unit admission.

This finding does not support the introduction of drying before wrapping in the thermal management bundle in very preterm infants at birth.

This randomized clinical trial compares plastic wrapping with or without drying for preventing heat loss at birth in very preterm infants.

Despite continuous improvements in neonatal resuscitation and stabilization in the last decades, thermal management immediately after birth remains an unresolved issue in preterm infants.

To compare 2 strategies of thermal management (plastic wrapping with or without drying) for preventing heat loss at birth in very preterm infants.

This multicenter, unblinded, randomized clinical trial was conducted among very preterm infants (birth weight <1500 g and/or gestational age ≤30 weeks 6 days) at 21 tertiary care hospitals in Italy from February 21, 2023, to July 18, 2024.

Eligible neonates were randomly allocated 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 participants with normothermia (36.5-37.5 °C) at admission to the neonatal intensive care unit (NICU). The secondary outcomes included hypothermia (<36.5 °C), moderate to severe hypothermia (<36.0 °C), and hyperthermia (>37.5 °C) at NICU admission, temperature at 1 hour after NICU admission, intraventricular hemorrhage, respiratory distress syndrome, late-onset sepsis, bronchopulmonary dysplasia, and mortality before hospital discharge.

Overall, 354 very preterm infants were randomized (180 [50.8%] female; mean [SD] gestational age, 28.6 [2.5] weeks); all received the allocated intervention and were included in the analysis. Normothermia at NICU admission was achieved in 81 of 177 dried infants (45.8%) and 82 of 177 undried infants (46.3%; risk ratio, 0.99; 95% CI, 0.79-1.24). The mean (SD) neonatal temperature at NICU admission was 36.4 °C (0.8 °C) in dried neonates and 36.5 °C (0.7 °C) in undried neonates (mean difference, −0.1 °C; 95% CI, −0.2 °C to 0.1 °C). In-hospital mortality included 26 of 177 dried neonates (14.7%) and 10 of 177 undried neonates (5.6%) (unadjusted risk ratio, 2.60; 95% CI, 1.29-5.23). The other secondary outcome measures were not different between the 2 arms.

In this multicenter randomized clinical trial, drying before plastic wrapping provided no benefit to very preterm infants in maintaining normothermia at NICU admission. Most deaths could be expected due to the compromised profile of the neonates, with no pathophysiological explanation related to the trial interventions. Approximately half of the infants were outside the normal thermal range at NICU admission; hence, thermal management remains a challenge requiring further investigations.

ClinicalTrials.gov Identifier: NCT05740072