NEONATOLOGY
HEAT LOSS PREVENTION SUIT
neohelpTM
NEONATAL HYPOTHERMIA: A WORLDWIDE ISSUE
neohelp
Hypothermia is an important factor in morbidity and mortality of all birth weights and gestational ages, and particularly for vulnerable preterm infants1
« The incidence of hypothermia is between 31% and 78% for those with birth weight less than 1500 g » 2
Stages of body temperature fluctuation1
Hypothermia
« Immediately after birth, neonates can lose heat [...] that can cause a reduction of up to 2°C of their body temperature within the first 10–20 min of birth » 3
« Infants at less than 28 weeks’ gestation have the highest incidence of hypothermia » 2
Consequences of hypothermia
Normothermia Hyperthermia
< 32°C
32-36°C
36-36.5°C
Severe hypothermia
Moderate hypothermia
Potential cold stress
36.5-37.5°C
Death
> 37.5°C
Intraventricular hemorrhage Respiratory distress
Four main factors of heat loss
Hypoglycemia
Evaporation From the humidified skin
Radiation Large areas of skin exposed to cooler surroundings
Brain damage
Hypoxia
Convection Cold air flows
Infection / Septicaemia
Coagulation defects
Metabolic acidosis
1
Each
Risk of sepsis +11%
in body temperature
Risk of death +28%
-1°C Conduction Contact with cold surfaces
neohelpTM, POLYETHYLENE OCCLUSIVE SUIT TO PREVENT HEAT LOSS
4
neohelp
neohelpTM is a sterile suit to swaddle the infant immediately after delivery (before resuscitation).
International recommendations
Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants Use of an occlusive polyethylene transparent wrap or bag immediately at birth improved admission temperatures in nonrandomised studies of infants at < 27 weeks’ gestation […], between 28 and 30, weeks […] and at < 33 weeks’ gestation […], as well as in very low birth weight infants and extremely 5 low birth weight infants when compared with routine care
Technical features Adjustable hood • Limits heat loss by radiation, convection and evaporation • Adjustable to the infant’s head
Double layer of Polyethylene • • •
Limits heat loss by convection and evaporation Allows good skin contact due to the thin inner layer Allows passage of radiant heat from the warmer6
Cochrane Database of Systematic Reviews - 2018
Pre-shaped foam cushion
Improvement in thermoregulation outcomes following the implementation of a thermoregulation bundle for preterm infants The key practice changes included: improved anticipation and staff preparedness, wrapping infant in a polyethylene sheet, using a polyethylene lined bonnet, using servo-control 1 mode at birth and during transport. Journal of Pediatrics and Child Health - 2022
According to UNICEF, such interventions can help reduce neonatal mortality or morbidity by 18-42 %8
• Limits heat loss by conduction • Helps to maintain an open airway (by raising the shoulders level)7 • Stabilises the infant’s position • Facilitates carrying of the infant • Provides comfort to the infant
Adapted materials •
•
Transparent and silent material that enables the visualization of the skin color and the infant’s breathing movement Non-toxic and biocompatible material (ISO 10993-1)
Central opening • Velcro® closure that ensures heat conservation • Easy and quick placement of the infant • Easy access to the infant’s body • Designed for easy placement of monitoring equipment, IV and umbilical catheters
CLINICAL STUDY: neohelpTM VS NON-STERILE PLASTIC BAG
9
neohelp
Evaluation of two polyethylene bags in preventing admission hypothermia in preterm infants : a quasi-randomized clinical trial; A. L. C. Possidente et al. Jornal de Pediatria - 2023
Objective
Results
This study aims to evaluate two polyethylene bags in preventing admission hypothermia (AH) in preterm infants, at a level III neonatal unit of the Women’s Hospital of the State University of Campinas in Brazil.
Frequency of admission hypothermia in each group
Study design 15%
171 preterm infants Between 24 and 33 GA Between 500 and 3000 g
14.7%
10%
2.6%
5%
95 preterm infants
76 preterm infants
Use of a non-sterile plastic bag
Use of neohelp
Non-sterile plastic bag
TM
neohelpTM
Observations regarding preterm infants using neohelp™ have shown: • significantly less frequent admission hypothermia • 86% risk reduction of the condition
Primary outcome: Admission hypothermia (axillary temperature at admission to the neonatal unit of <36.0 °C)
Conclusion Based on these results, the suggested benefits are the following
• n eohelp™ is more effective in reducing admission hypothermia in infants born at < 34 weeks
General warning: Preterm infants have reduced disabilities to dissipate heat, that is why hyperthermia is an important issue to be considered carefully. The regular monitoring of the newborn’s temperature is essential.
INDICATIONS FOR USE
neohelp
neohelpTM is the solution to prevent hypothermia in the following situations:
Delivery room
NICU
Transport From delivery room to NICU
Cesarean Delayed cord clamping (DCC) Resuscitation
From hospital to hospital
PICC placement
Scan the QR code
Umbilical catheter placement
Scan the QR code
Scan the QR code
Unplanned delivery Scan the QR code
Protocol for DCC in premature infants < 34 weeks successfully utilized polyethylene wraps […] to prevent hypothermia in both vaginal as well as 10 cesarean deliveries
The plastic drape reduced the hypothermia rate in the NICU for VLBW neonates during PICC placement 11 compared with cloth blanket/towels
Each QR will lead you to a more detailed document regarding each of the indications for use.
The transport incubator used to limit heat loss can be cumbersome and difficult to obtain. It may be « replaced » by […] a transparent polyethylene bag wrapping whilst the baby is still wet. This greatly 12 reduces the risk of hypothermia
HOW TO USE neohelpTM
neohelp
37°
1) Unfold neohelp™ completely. 2) P lace it on the resuscitation table, under the heat lamp (if applicable). 3) F ully open the Velcro® and the hood to facilitate the infant’s reception.
4) Do not dry the baby at birth. 5) Place the baby immediately after birth in neohelp™. 6) Align the shoulders at the upper edges of the foam. 7) Easily close the Velcro® tightly along its entire length.
8) Adjust the hood to the head of the infant. Do not cover the airways due to the risk of suffocation. 9) Other heating appliances will need to be adjusted accordingly due to risk of hyperthermia.
10) The infant should be kept wrapped until temperature stabilization. 11) Temperature of the infant should be monitored continuously or consecutively (ideally every 5 minutes). 12) Do not use more than 24 hours.
Technical features
Designation
Dimensions
Code
Quantity
neohelpTM SMALL < 1KG
L. 38 x W. 30 cm
37.09.14
10/box
neohelpTM MEDIUM 1KG - 2.5KG
L. 44 x W. 38 cm
37.09.15
10/box
neohelpTM LARGE > 2.5KG
L. 50 x W. 38 cm
37.09.16
10/box
13) neohelp™ is suitable with the use of an hemostatic device to eliminate bleeding from the cord vessels. 14) If a medical device such as an umbilical catheter is needed, simply open the Velcro®, insert the device, and once again easily close the Velcro® along its entire length.
References 1. S ingh TS, Skelton H, Baird J, Padernia AM, Maheshwari R, Shah DM, D’Cruz D, Luig M, Jani P. Improvement in thermoregulation outcomes following the implementation of a thermoregulation bundle for preterm infants. J Paediatr Child Health. 2022 Jul;58(7):1201-1208. doi: 10.1111/jpc.15949. Epub 2022 Mar 30. PMID: 35353411; PMCID: PMC9310766. 2. M anani M, Jegatheesan P, DeSandre G, Song D, Showalter L, Govindaswami B. Elimination of admission hypothermia in preterm very low-birth-weight infants by standardization of delivery room management. Perm J. 2013 Summer;17(3):8-13. doi: 10.7812/TPP/12-130. PMID: 24355884; PMCID: PMC3783084. 3. Alebachew Bayih W, Assefa N, Dheresa M, Minuye B, Demis S. Neonatal hypothermia and associated factors within six hours of delivery in eastern part of Ethiopia: a crosssectional study. BMC Pediatr. 2019 Jul 24;19(1):252. doi: 10.1186/s12887-019-1632-2. PMID: 31340772; PMCID: PMC6651976. 4. Vohra S, Roberts RS, Zhang B, Janes M, Schmidt B. Heat Loss Prevention (HeLP) in the delivery room: A randomized controlled trial of polyethylene occlusive skin wrapping in very preterm infants. J Pediatr. 2004 Dec;145(6):750-3. doi: 10.1016/j.jpeds.2004.07.036. PMID: 15580195. 5. M cCall EM, Alderdice F, Halliday HL,Vohra S, Johnston L. Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2018 Feb 12;2(2):CD004210. doi: 10.1002/14651858.CD004210.pub5. PMID: 29431872; PMCID: PMC6491068. 6. Thalia Cordaro, Ann Gibbons Phalen, Ksenia Zukowsky. Hypothermia and Occlusive skin wrap in the low birth weight premature infant: an evidentiary review. NAINR. 2012;12(2):78-85 7. Australian and New Zealand Committee on Resuscitation. (2021). ANZCOR Guideline 13.4 Airway Management and Mask Ventilation of the Newborn- April 2021. Retrieved from https://www.resus.org.nz/assets/Uploads/ANZCOR-Guideline-13.4-April-2021.pdf 8. Wariki WMV and Mori R. Interventions to prevent hypothermia at birth in preterm and/or low-birth-weight infants: RHL commentary (last revised: 1 June 2010). The WHO Reproductive Health Library; Geneva: World Health Organization.
10. C hantry CJ, Blanton A, Taché V, Finta L, Tancredi D. Delayed cord clamping during elective cesarean deliveries: results of a pilot safety trial. Matern Health Neonatol Perinatol. 2018 Jul 4;4:16. doi: 10.1186/s40748-018-0083-3. PMID: 29997897; PMCID: PMC6031144. 11. P han HKT, McIntyre TM. Using a Plastic Drape to Reduce Hypothermia in Premature Neonates During Peripherally Inserted Central Catheter Placement. Adv Neonatal Care. 2022 Jun 1;22(3):193-202. doi: 10.1097/ANC.0000000000000906. Epub 2021 Jun 16. PMID: 34138792. 12. J.F. Diependaele, A. Fily. Management of a newborn baby – 51st congress of French Society of Anesthesia and Intensive Care - 2009
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9. P ossidente ALC, Bazan IGM, Machado HC, Marba STM, Caldas JPS. Evaluation of two polyethylene bags in preventing admission hypothermia in preterm infants: a quasirandomized clinical trial. J Pediatr (Rio J). 2023 Sep-Oct;99(5):514-520. doi: 10.1016/j.jped.2023.04.004. Epub 2023 May 10. PMID: 37172616; PMCID: PMC10492142.