“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 in 2011 Feasible, but regular incidents of hypothermia 1 literature review, 3 audits and 1 pilot RCT¹ to review the problem Pilot RCT published PhD started Ongoing Systematic Review² and full size RCT 1 Newborn babies are predisposed to Hypothermia therefore increasing risks of hypoglycaemia and associated complications Maternal analgesic requirements and risk of sepsis and haemorrhage increase with post operative hypothermia 2 Facilitate Skin to skin contact¹ immediately after delivery Neonatal Temperature check after skin to skin in theatre and in PACU Maternal temperature check x 2 in PACU Babies transferred skin to skin in mothers arms Nappy, blankets Hat

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 ¹Standards: babies dressed with hat and nappy Wrapped 2blankets and a towel Warm under ohio prior removing from OT Check 4 anxilliary temps with the same digital thermometer (say where) Document room temps from each case (both OT and PACU) Babies dressed before T/f to wards

Results Temperature checks Warm fluids group hypothermia Usual care group P value* Pre-anaesthesia 0/10♀ P= .673 During CS 1/10♀ (35.9°C) 3/10♀ (mean 35.8°C) P= .016 In PACU 4/10♀ (BH given) P= .005 On admission to PSNT 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 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 Limitations: 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 Person(s) Responsible Timeframe Progress to date Disseminate study results to theatre staff/managers A. Vilinsky April 2015 completed Maternal temperatures to be checked peri-operatively and findings documented OT nurses/midwives To be commenced July 2015 Full size RCT study to take place To be commenced December 2016 ongoing Publication of pilot RCT findings Undertake a Systematic Review A. Vilinsky, Sheridan, L. Nugent A. Vilinsky, L. Nugent To be completed by the end of 2015 To be commenced March 2016 Completed

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. 151-157. 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.

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