48 Heat Loss Prevention in the Delivery Room: A Systematic Review of the Effectiveness of Occlusive Skin Wrap
Bibliographic record
Abstract
To systematically identify and synthesize primary studies that evaluated the effectiveness of occlusive skin wrap for reducing heat loss and/or mortality in premature infants in the delivery room. A comprehensive search of MEDLINE, EMBASE, CINAHL and Web of Science identified studies that compared occlusive skin wrap versus standard care. Searches were screened and two reviewers independently applied inclusion criteria. The primary outcome was admission temperature. Other outcomes included: mortality, incidence of hypothermia, major brain injury, duration of hospitalization, one-hour rectal temperature, duration of oxygen therapy, and APGAR at one and five minutes. Data were extracted by one reviewer and checked by a second reviewer; data were analyzed using standard Cochrane methodology. Analyses were sub-grouped by study design (randomized controlled trial [RCT] vs non-RCT); RCTs were grouped according to gestational age of the study subjects (<29 weeks, 29–33 weeks). Selected studies were assessed for methodological quality using the Downs and Black checklist. Five studies met the inclusion criteria: three RCTs, one prospective cohort, and one historical control. Overall, 166 infants were treated with occlusive skin wrap (95 RCT, 71 other designs) and 231 infants received standard care (105 RCT, 126 other). The overall quality of the studies was high with a median quality index of 26 out of 29 (inter-quartile range 22–27). For admission rectal temperature, there were significant differences favoring wrap for infants <29 weeks (based on 3 RCTs; WMD 1.03 C, 95% CI 0.29,1.77) and among the non-RCTs (n=2; WMD 0.93 C, 95% CI 0.64,1.22); there was no significant difference for infants 29–33 weeks (based on 1 RCT; WMD 0.17 C, 95% CI −0.27,0.61). Based on data from the three RCTs, there was no significant difference in mortality between the two treatment groups (<29 wks: RD −0.08, 95% CI −0.19,0.04); 29–33 wks: RD −0.10, 95% CI −0.31–0.11). Publication bias was not assessed due to the small number of studies. The evidence indicates that occlusive skin wrap is more effective than standard care at reducing heat loss among very young babies (<29 weeks). A significant difference in mortality was not found between the wrapped and non-wrapped groups. However the direction in effect was consistent in favor of occlusive skin wrap suggesting that there may be a lack of power for this outcome. Further large, multi-centered trials are required to gather samples of sufficient size to adequately assess all clinically important outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.061 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.010 |
| Bibliometrics | 0.011 | 0.012 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".