1. “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

2. 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

3. 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

4. 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

5. 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)

6. 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

7. 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

8. 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
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
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
Waldron, S. and MacKinnon, R. (2007) ‘Neonatal Thermoregulation’. Infant. 3(3), pp
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.

9. Any questions?