Francesco Cavallin1, Giulia Segafredo2, Damiano Pizzol2,3, William Massavon4, Marta Lusiani5, Olivier Wingi6, Manuela De Vivo7, Liviana Da Dalt8, Chiara Boscardin8, Fabio Manenti2, Giovanni Putoto2, Daniele Trevisanuto9. 1. Independent statistician, Padua, Italy. 2. Doctors with Africa CUAMM, Padua, Italy. 3. Doctors with Africa CUAMM, Beira, Mozambique. 4. Doctors with Africa CUAMM, Oyam District, Uganda. 5. Doctors with Africa CUAMM, Wolisso, Ethiopia. 6. Department of Pediatrics and Neonatology, Central Hospital of Beira, Beira, Mozambique. 7. Doctors with Africa CUAMM, Aber, Uganda; and. 8. Department of Women's and Children's Health, University of Padua, Padua, Italy. 9. Department of Women's and Children's Health, University of Padua, Padua, Italy daniele.trevisanuto@gmail.com.
Abstract
BACKGROUND AND OBJECTIVES: World Health Organization guidelines recommend covering the head during kangaroo mother care (KMC), but the effect of a cap on neonatal thermal control during KMC remains to be defined. Our objective was to assess the effectiveness and safety of a woolen cap in maintaining low birth weight infants (LBWIs) in normal thermal range during KMC. METHODS:Three hundred LBWI candidates for KMC in 3 African hospitals were randomly assigned to KMC with (CAP group) or without (NOCAP group) a woolen cap in a 1:1 ratio during the first week after birth. Axillary temperature was measured every 6 hours. Maternal and room temperature and adherence to skin-to-skin contact were registered at the same time points. RESULTS: A total number of 5064 measurements were recorded (median 19 measurements per subject; interquartile range: 10-25). Mean time spent in normal temperature range was 55% (SD 24) in CAP and 56% (SD 24) in NOCAP groups. Multivariable analysis estimated a rate ratio of 0.92 (95% confidence interval: 0.84 to 1.00; P = .06) for the effect of the cap versus no cap on time spent in the normal temperature range. CONCLUSIONS: In these 3 African, low-resource settings and so many days post birth, the use of a woolen cap was safe but provided no advantages in maintaining LBWI in the normal thermal range while being in a KMC ward. LBWIs spent only half of the time in the normal temperature range despite warm rooms and skin-to-skin contact. Maintaining normothermia in LBWIs remains an unfinished challenge in low-resource settings.
RCT Entities:
BACKGROUND AND OBJECTIVES: World Health Organization guidelines recommend covering the head during kangaroo mother care (KMC), but the effect of a cap on neonatal thermal control during KMC remains to be defined. Our objective was to assess the effectiveness and safety of a woolen cap in maintaining low birth weight infants (LBWIs) in normal thermal range during KMC. METHODS: Three hundred LBWI candidates for KMC in 3 African hospitals were randomly assigned to KMC with (CAP group) or without (NOCAP group) a woolen cap in a 1:1 ratio during the first week after birth. Axillary temperature was measured every 6 hours. Maternal and room temperature and adherence to skin-to-skin contact were registered at the same time points. RESULTS: A total number of 5064 measurements were recorded (median 19 measurements per subject; interquartile range: 10-25). Mean time spent in normal temperature range was 55% (SD 24) in CAP and 56% (SD 24) in NOCAP groups. Multivariable analysis estimated a rate ratio of 0.92 (95% confidence interval: 0.84 to 1.00; P = .06) for the effect of the cap versus no cap on time spent in the normal temperature range. CONCLUSIONS: In these 3 African, low-resource settings and so many days post birth, the use of a woolen cap was safe but provided no advantages in maintaining LBWI in the normal thermal range while being in a KMC ward. LBWIs spent only half of the time in the normal temperature range despite warm rooms and skin-to-skin contact. Maintaining normothermia in LBWIs remains an unfinished challenge in low-resource settings.
Authors: Josee Uwamariya; Christian Mazimpaka; Leana May; Alphonse Nshimyiryo; Henry A Feldman; Felix Sayinzoga; Sharon Umutesi; Ashok Gadgil; Vi H Rapp; Evrard Nahimana; Anne Hansen Journal: EClinicalMedicine Date: 2021-04-16