“Preventing peri-operative maternal and
neonatal hypothermia after skin-to skin
contact: a pilot RCT study”
Mrs Aliona Vilinsky-Redmond
BSc, RM, MSc, RMT
Staff midwife-PhD student
Background
-current practice and problem-
• SSC started in OT on 2011
• Feasible but regular incidents of hypothermia
• 1 literature review, 3 audits and 1 pilot RCT¹ to
review the problem
• Pilot RCT published
Hat
• PhD started
• Ongoing Systematic Review² and full size RCT
Nappy,
blankets
Objectives
• Review the feasibility of a future RCT
• Determine the sample size of the study
population
• active peri-operative warming Vs current
practice-> prevents neonatal hypothermia
during/after SSC up to 2 h post-delivery?
He’s the father
not the
anesthetist
Methods and Sample
Methods: Randomised°, single-blinded¹, interventional² study
Ethical approval: Rotunda REC (approved December 2014)
Sample size: (20 mothers/babies)
 10 intervention group (IV fluids warmed to 39°C)
 10 usual care group (IV fluids at room temperature 25°C approx.)
Data collection: prospective observational data (T measurements)¹ captured on
hardcopy audit tool (collected between January-February 2015)
Data analysis: MS Excel, SPSS version 22 (Mann-Whitney test)
Excluded criteria:
 Babies born vaginally
 Babies born outside theatre hours (08:00-16:00) or at weekends
 High risk babies ie. Preterm deliveries, congenital anomalies, multiple births
 Babies born by Emergency LSCS
 Women under GA
Results
Temperature
checks
Warm fluids group
hypothermia
Pre-anaesthesia
0/10♀
0/10♀
P= .673
During CS
1/10♀ (35.9°C)
3/10♀
(mean 35.8°C)
P= .016
In PACU
0/10♀
4/10♀ (BH given)
P= .005
On admission to
PSNT
0/10♀
2/10♀
(35.8°C & 35.9°C)
P= .989
SSC time
81.3 minutes
82 minutes
P= .983
Mean OT
temperature
24.04°C
25.22°C
P= .045


Usual care group
hypothermia
P value*
No statistical significant differences between new-born T in both groups (p= .057)
Clinically significant as 3/10 babies (control group) became mildly hypothermic
(36.1°C and 36.2°C) Vs 1/10 baby (intervention) (36.4°C)
Conclusions
• Use of pre-warmed IV fluids reduced the incidence of maternal
peri-operative hypothermia in comparison with the standard
care group
• Still uncertain as to whether it had any significant effect on the
prevention of neonatal hypothermia
• Limitations:
 Study was single-blinded
 Room T in OT/PACU were difficult to maintain at a
standard temperature due to air-conditioning dysfunctions
at the time of the data collection
 Room T difference between the two groups, could
potentially be a major bias in this study
Action plan
Action Required
Disseminate study results to
theatre staff/managers
Maternal temperatures to be
checked peri-operatively
and findings documented
Person(s)
Responsible
Timeframe
Progress to
date
completed
A. Vilinsky
OT nurses/midwives
-
April 2015
-
To be commenced July
2015
completed
ongoing
Full size RCT study to take
place
Publication of pilot RCT
findings
A. Vilinsky
A. Vilinsky,
A. Sheridan,
L. Nugent
Undertake a Systematic Review A. Vilinsky, L. Nugent
-
To be commenced
December 2016
-
To be completed by the
end of 2015
Completed
-
To be commenced
March 2016
ongoing
References
• Gouchon, S., Gregori, D., Picotto, A., Patrucco, G., Nangeroni, M., and Di
Giulio, P. (2010) ‘Skin-to-Skin Contact After Cesarean Delivery: An
Experimental Study’. Journal of Nursing Research. 59(2), pp. 78-84.
• Nolan, A. and Lawrence, C. (2009) ‘A Pilot Study of a Nursing Intervention
Protocol to Minimize Maternal-Infant Separation After Cesarean Birth’.
Journal of Obstetric, Gynaecologic, & Neonatal Nursing. 38, pp. 430-442.
• Takahashi, Y., Tamakoshi, K., Matsushima, M., Kawabe, T. (2011)
‘Comparison of salivary cortisol, heart rate, and oxygen saturation
between early skin-to-skin contact with different initiation and duration
times in healthy, full-term infants’. Early Human Development. 87, pp. 151157.
• Waldron, S. and MacKinnon, R. (2007) ‘Neonatal Thermoregulation’.
Infant. 3(3), pp. 101-104.
• World Health Organisation (1997) ‘Thermal protection of the newborn: a
practical guide’. Maternal and Newborn Health/Safe Motherhood Unit,
Division of Reproductive Health. Geneva: World Health Organisation.
Any questions?