Application of Plastic Wrap to Improve Temperatures in Infants Born Less Than 30 Weeks Gestation: A Randomized Controlled Trial

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The primary aim of the study was to evaluate whether the application of a plastic wrap immediately after birth is more effective than the standard care of temperature management for improving admission temperatures to the neonatal intensive care unit (NICU) in infants <30 weeks gestation.


A randomized controlled trial was conducted. Infants in the intervention group were transferred to a prewarmed radiant heater immediately after birth and encased in NeoWrap from the neck down without being dried. The infant's head was dried with a prewarmed towel and a hat added. The control group received usual care for the unit; the infant was transferred to the prewarmed radiant warmer and dried, and warm towels and a hat are then applied.


A total of 92 infants were analyzed: 49 in the control group and 43 in the intervention group; 48 (52.2 percent) were <27 weeks gestation, and 44 (47.8 percent) were <30 weeks gestation. The infants' temperatures were assessed for two hours following admission.

Main Outcome Variable:

The application of a plastic wrap and hat significantly increased NICU admission temperature in infants <30 weeks gestation.


Of the 92 infants, 43 (51.2 percent <27 weeks and 48.8 percent <30 weeks) were randomized to the experimental group and 49 (53.1 percent <27 weeks and 46.9 percent <30 weeks) to the control group. The mean first temperature was 36.15°C (SD = 0.85) for intervention and 35.81°C (SD = 0.91) for control infants (p=.074); whereas the respective admission temperatures were 36.26°C (SD = 0.68; n = 42) and 35.79°C (SD = 0.77; n = 44; p=.004). The mean temperature of the infants rose steadily from the time of birth to two hours follow-up in both the intervention (36.15°-37.03°C; SD = 0.49; n = 40) and control groups (35.81°-36.75°C; SD = 0.70; n = 47; p<.001, respectively).

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