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Newborn Hypothermia following Caesarean delivery; Is skin-to-skin a cause?
Abstract Number: F5A-4
Abstract Type: Original Research
Introduction: The ‘gentle C section’ is gaining popularity amongst providers. Early skin-to-skin contact between mother and newborn is a cornerstone of this approach. Logistical barriers against providing early skin-to-skin are well recognized and concern over the newborns temperature in this immediate period have been made. An audit was conducted to look at temperature changes in newborns undergoing early skin-to-skin contact on our unit.
Methods: Data from 50 elective and emergency caesarean deliveries was prospectively collected during October 2016. The primary outcome was temperature change in the newborn. The newborn’s temperature was recorded immediately after birth in theatre and in the recovery suite. Other data collected included temperature of the mother both in theatre and the recovery suite, details of warming adjuncts used, length of surgery and length of skin-to-skin contact. Factors precluding early skin-to-skin contact such as maternal instability, neonate requiring resuscitation and maternal refusal were also noted.
Results: Mean change in newborn temperature between theatre and recovery without skin-to-skin contact was +0.18 ºC (SD±0.2, 95% CI+0.04-+0.31) and following early skin-to-skin contact was - 0.19ºC (SD ±0.46, 95% CI-0.42--0.03). Newborn temperatures were lower following skin-to-skin contact (p=0.031, unpaired t test). Early skin-to-skin contact was performed in 22 (44%) cases. Maternal refusal accounted for 12 (43%) cases with no skin-to-skin contact. One baby was admitted to NICU with hypothermia following 10 minutes of skin-to-skin contact in theatre. Fluid warming adjuncts were used in 17 (34%) of cases. Mean duration of skin-to-skin contact in theatre was 14.3 minutes (SD ±8.9).
Discussion: The mean temperature of newborns who did not have early skin-to-skin contact increased from theatre to the recovery suite. Those that did have early skin-to-skin contact became colder from the time of commencing skin-to-skin to the recovery suite. Newborn temperatures in the recovery suite were lower in those that had early skin-to-skin contact. In light of these results, our unit is implementing the use of an upper body forced air –warming blanket for use during caesarean delivery and will advocate the use of fluid warmers in all caesarean deliveries in line with evidence that this may impact on neonatal temperatures (1).
1. Vilinsky-Redmond, Aliona & Sheridan, Ann & Nugent, Linda. (2016). Preventing peri-operative maternal and neonatal hypothermia after skin-to-skin contact. Journal of Neonatal Nursing. . 10.1016/j.jnn.2016.02.002.