The Incidence and Prevention of Hypothermia in Newborn Bonding after Cesarean Delivery: A Randomized Controlled Trial

Horn, Ernst-Peter MD*; Bein, Berthold MD; Steinfath, Markus MD; Ramaker, Kerstin MD; Buchloh, Birgit; Höcker, Jan MD

doi: 10.1213/ANE.0000000000000160
Obstetric Anesthesiology: Research Report

BACKGROUND: Little is known about thermoregulation of the newborn while bonding on the mother’s chest immediately after cesarean delivery. Newborn hypothermia is associated with serious complications and should be avoided. Therefore, we evaluated whether newborns develop hypothermia during intraoperative bonding while positioned on their mothers’ chests and investigated the effects of active cutaneous warming of the mothers and babies during a 20-minute intraoperative bonding period.

METHODS: We enrolled 40 parturients scheduled for elective cesarean delivery under spinal anesthesia. Mothers and their newborns were randomized to receive either passive insulation or forced-air skin-surface warming during the surgical procedure and bonding period. The primary outcome was neonatal core temperature at the end of the bonding period. Core temperatures of the newborns were measured with a rectal probe. Body temperatures of the mothers were assessed by sublingual measurements. Skin temperatures, thermal comfort of the mothers, and perioperative shivering were evaluated.

RESULTS: Without active warming from the beginning of the surgical procedure until the end of the bonding period, the mean (SD) neonatal core temperature decreased to 35.9 (0.6)°C. Seventeen of 21 (81%) newborns became hypothermic (defined as a core temperature below 36.5°C). Active skin-surface warming from the beginning of the surgical procedure until the end of the bonding period resulted in a neonatal core temperature of 37.0 (0.2)°C and a decreased incidence of hypothermia (1 of 19 (5%) newborns (P < 0.0001)). In addition, active warming increased the mean skin temperatures of the infants, maternal core and skin temperatures, maternal thermal comfort, and reduced perioperative shivering.

CONCLUSIONS: Active forced-air warming of mothers and newborns immediately after cesarean delivery reduces the incidence of infant and maternal hypothermia and maternal shivering, and increases maternal comfort.

From the *Departments of Anesthesiology and Intensive Care Medicine, Regio Klinikum Pinneberg, Pinneberg, Germany; Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; and Department of Gynecology and Obstetrics, Regio Klinikum Pinneberg, Pinneberg, Germany.

Accepted for publication December 9, 2013

Funding: This study was funded by the Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.

The authors declare no conflicts of interest.

This report was previously presented, in part, at the 60. Deutscher Anaesthesie Congress (DAC), Nuernberg, Germany, April 20–22, 2013.

Reprints will not be available from the authors.

Address correspondence to Jan Höcker, MD, Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany, Schwanenweg 21, 24105 Kiel, Germany. Address e-mail to jan.hoecker@uksh.de.

© 2014 International Anesthesia Research Society