塑料薄膜包裹预防新生儿低体温有效性及安全性的系统评价
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摘要
目的系统评价塑料薄膜包裹对新生儿保暖效果的有效性及安全性,以期为临床新生儿保暖措施的选择提供依据。方法计算机检索Cochrane Library、Pub Med、Scopus、中国生物医学文献数据库、万方、维普、中国学术期刊全文数据库等国内外数据库中有关塑料薄膜包裹应用于新生儿保暖的随机对照研究。对所得文献依据纳入与排除标准进行筛查,提取资料,评价文献质量,采用Rev Man 5.2软件进行Meta分析。结果最终纳入16项随机对照试验,包括2 836例研究对象。Meta分析结果显示,塑料薄膜包裹组早产儿进入NICU时低体温发生率[RR=0.71,95%CI (0.64,0.79),P<0.01]、进入NICU时体温[MD=0.60,95%CI (0.47,0.72),P<0.01]、进入NICU时发热发生率[RR=4.09,95%CI(2.12,7.88),P<0.01]与常规护理组相比,差异具有统计学意义;Ⅲ度或Ⅳ度脑室内出血发生率[RR=0.92,95%CI(0.65,1.32),P=0.660]、出院前病死率[RR=0.75,95%CI(0.53,1.08),P=0.120]与常规护理组相比,差异无统计学意义。结论塑料薄膜包裹能减少早产儿进入NICU时低体温的发生率,提高早产儿进入NICU时的体温,可以作为一种有效的早产儿保暖方法,但有引起发热的风险;塑料薄膜包裹不能降低早产儿Ⅲ度或Ⅳ度脑室内出血发生率及出院前病死率。
Objective To systematically evaluate the efficacy and safety of plastic wrap for prevention of hypothermia in newborn infants. Methods We searched databases including Cochrane Library,PubMed,Scopus,CINAHL,CBM,Wanfang,VIP,and CNKI. We included all randomized controlled trials which investigated the efficacy and safety of plastic wrap on prevention of hypothermia in newborn infants. Studies were selected according to inclusion and exclusion criteria,data were extracted and study quality was appraised. RevMan 5.2 software was used to analyze the data. Results Sixteen randomized controlled trials which included 2 836 participants were included.The results of meta-analysis showed that hypothermia on admission to the NICU [RR=0.71,95%CI(0.64,0.79),P<0.01],core body temperature on admission to the NICU [MD=0.60,95%CI(0.47,0.72),P<0.01],and hyperthermia on admission to the NICU[RR=4.09,95%CI(2.12,7.88),P<0.01] in the wrapped group were significantly different with those received routine care. There was no significant difference in IVH(grades Ⅲ or Ⅳ) [RR =0.92,95% CI(0.65,1.32),P=0.66] and death during hospital stay [RR=0.75,95%CI(0.53,1.08),P=0.12] between the wrapped group and control group. Conclusion Usage of plastic wrap compared with routine care can lead to less hypothermia on admission to NICUs with higher temperature among premature infants(<28 weeks,or ≥28 weeks premature infants). Caution must be taken to avoid iatrogenic hyperthermia. Plastic wrap cannot decrease the rate of IVH(grades Ⅲ or Ⅳ) and mortality during hospital stay in premature infants.
Objective To systematically evaluate the efficacy and safety of plastic wrap for prevention of hypothermia in newborn infants. Methods We searched databases including Cochrane Library,PubMed,Scopus,CINAHL,CBM,Wanfang,VIP,and CNKI. We included all randomized controlled trials which investigated the efficacy and safety of plastic wrap on prevention of hypothermia in newborn infants. Studies were selected according to inclusion and exclusion criteria,data were extracted and study quality was appraised. RevMan 5.2 software was used to analyze the data. Results Sixteen randomized controlled trials which included 2 836 participants were included.The results of meta-analysis showed that hypothermia on admission to the NICU [RR=0.71,95%CI(0.64,0.79),P<0.01],core body temperature on admission to the NICU [MD=0.60,95%CI(0.47,0.72),P<0.01],and hyperthermia on admission to the NICU[RR=4.09,95%CI(2.12,7.88),P<0.01] in the wrapped group were significantly different with those received routine care. There was no significant difference in IVH(grades Ⅲ or Ⅳ) [RR =0.92,95% CI(0.65,1.32),P=0.66] and death during hospital stay [RR=0.75,95%CI(0.53,1.08),P=0.12] between the wrapped group and control group. Conclusion Usage of plastic wrap compared with routine care can lead to less hypothermia on admission to NICUs with higher temperature among premature infants(<28 weeks,or ≥28 weeks premature infants). Caution must be taken to avoid iatrogenic hyperthermia. Plastic wrap cannot decrease the rate of IVH(grades Ⅲ or Ⅳ) and mortality during hospital stay in premature infants.
引文
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[3]WHO.Safe motherhood:thermal protection of the newborn:a practical guide[S].Geneva:WHO Organization,1997.
[4]Mullany LC,Katz J,Khatry SK,et al.Risk of mortality associated with neonatal hypothermia in southern Nepal[J].Arch Pediatr Adolesc Med,2010,164(7):650-656.
[5]Chang H,Sung Y,Wang S,et al.Short-and long-term outcomes in very low birth weight infants with admission hypothermia[J].Plos One,2015,10(7):e131976.
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[12]Leadford AE,Warren JB,Manasyan A,et al.Plastic bags for prevention of hypothermia in preterm and low birth weight infants[J].Pediatrics,2013,132(1):e128-e134.
[13]Reilly MC,Vohra S,Rac VE,et al.Randomized trial of occlusive wrap for heat loss prevention in preterm infants[J].JPediatr,2015,166(2):e262-e268.
[14]Trevisanuto D,Doglioni N,Cavallin F,et al.Heat loss prevention in very preterm infants in delivery rooms:a prospective,randomized,controlled trial of polyethylene caps[J].J Pediatr,2010,156(6):914-917.
[15]柳艳丽,周薇,唐震海,等.塑料薄膜包裹对极低出生体重儿入院体温的影响[J].中华围产医学杂志,2014,17(4):244-248.
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[17]Rohana J,Khairina W,Boo N Y,et al.Reducing hypothermia in preterm infants with polyethylene wrap[J].Pediatr Int,2011,53(4):468-474.
[18]周微.极低出生体重儿发生入院低体温的危险因素分析及塑料薄膜封闭式包裹对早产儿入院体温的影响[D].温州:温州医科大学,2009.
[19]Shabeer MP,Abiramalatha T,Devakirubai D,et al.Standard care with plastic bag or portable thermal nest to prevent hypothermia at birth:a three-armed randomized controlled trial[J].J Perinatol,2018,38(10):1324-1330.
[20]Nimbalkar SM,Khanna AK,Patel DV,et al.Efficacy of polyethylene skin wrapping in preventing hypothermia in preterm neonates(<34 weeks):a parallel group non-blinded randomized control trial[J].J Trop Pediatr,2018,20(3):22-26.
[21]Talakoub S,Shahbazifard Z,Armanian AM,et al.Effect of two polyethylene covers in prevention of hypothermia among premature neonates[J].Iran J Nurs Midwifery Res,2015,20(3):322-326.
[22]Vohra S,Frent G,Campbell V,et al.Effect of polyethylene occlusive skin wrapping on heat loss in very low birth weight infants at delivery:a randomized trial[J].J Pediatr,1999,134(5):547-551.
[23]Vohra S,Roberts RS,Zhang B,et al.Heat loss prevention(He LP)in the delivery room:a randomized controlled trial of polyethylene occlusive skin wrapping in very preterm infants[J].J Pediatr,2004,145(6):750-753.
[24]郑园园,叶旭萍,王晓,等.塑料薄膜包裹转运法对早产儿体温影响的研究[J].护理管理杂志,2016,16(4):294-296.
[25]Raman S,Shahla A.Temperature drop in normal term newborn infants born at the University Hospital,Kuala Lumpur[J].Aust N Z J Obstet Gynaecol,1992,32(2):117-119.
[26]邢丽云,黄丽华.早产儿保暖措施的研究进展[J].中华护理杂志,2017,52(2):230-233.
[27]Matthew B,Lakshminrusimha S,Cominsky K,et al.Vinyl bags prevent hypothermia at birth in preterm infants[J].Indian JPediatr,2007,74(3):249-253.
[28]Ibrahim CP,Yoxall CW.Use of plastic bags to prevent hypothermia at birth in preterm infants-do they work at lower gestation?[J].Acta Paediatr,2009,98(2):256-260.
[29]Singh A,Duckett J,Newton T,et al.Improving neonatal unit admission temperatures in preterm babies:exothermic mattresses,polythene bags or a traditional approach?[J].J Perinatol,2010,30(1):45-49.
[30]Gunn AJ,Gluckman PD.Should we try to prevent hypothermia after cardiac arrest?[J].Pediatrics,2000,106(3):132-133.
[31]Gunn AJ,Bennet L.Is temperature important in delivery room resuscitation?[J].Semin Neonatol,2001,6(3):241-249.
[32]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011.
[2]Vento M,Lista G.Managing preterm infants in the first minutes of life[J].Paediatr Respir Rev,2015,16(3):151-156.
[3]WHO.Safe motherhood:thermal protection of the newborn:a practical guide[S].Geneva:WHO Organization,1997.
[4]Mullany LC,Katz J,Khatry SK,et al.Risk of mortality associated with neonatal hypothermia in southern Nepal[J].Arch Pediatr Adolesc Med,2010,164(7):650-656.
[5]Chang H,Sung Y,Wang S,et al.Short-and long-term outcomes in very low birth weight infants with admission hypothermia[J].Plos One,2015,10(7):e131976.
[6]Agourram B,Bach V,Tourneux P,et al.Why wrapping premature neonates to prevent hypothermia can predispose to overheating[J].J Appl Physiol,2010,108(6):1674-1681.
[7]Oatley HK,Blencowe H,Lawn JE.The effect of coverings,including plastic bags and wraps,on mortality and morbidity in preterm and full-term neonates[J].J Perinatol,2016,36(1):S83-S89.
[8]Li S,Guo P,Zou Q,et al.Efficacy and safety of plastic wrap for prevention of hypothermia after birth and during NICU in preterm infants:a systematic review and Meta-analysis[J].PLos One,2016,11(6):e0156960.
[9]Belsches TC,Tilly AE,Miller T R,et al.Randomized trial of plastic bags to prevent term neonatal hypothermia in a resource-poor setting[J].Pediatrics,2013,132(3):e656-e661.
[10]Mccall EM,Alderdice F,Halliday HL,et al.Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants[J].Cochrane Database Syst Rev,2010,17(3):D4210.
[11]Smith J,Usher K,Alcock G,et al.Application of plastic wrap to improve temperatures in infants born less than 30 weeks gestation:a randomized controlled trial[J].Neonatal Netw,2013,32(4):235-245.
[12]Leadford AE,Warren JB,Manasyan A,et al.Plastic bags for prevention of hypothermia in preterm and low birth weight infants[J].Pediatrics,2013,132(1):e128-e134.
[13]Reilly MC,Vohra S,Rac VE,et al.Randomized trial of occlusive wrap for heat loss prevention in preterm infants[J].JPediatr,2015,166(2):e262-e268.
[14]Trevisanuto D,Doglioni N,Cavallin F,et al.Heat loss prevention in very preterm infants in delivery rooms:a prospective,randomized,controlled trial of polyethylene caps[J].J Pediatr,2010,156(6):914-917.
[15]柳艳丽,周薇,唐震海,等.塑料薄膜包裹对极低出生体重儿入院体温的影响[J].中华围产医学杂志,2014,17(4):244-248.
[16]Knobel RB,Wimmer JE Jr,Holbert D.Heat loss prevention for preterm infants in the delivery room[J].J Perinatol,2005,25(5):304-308.
[17]Rohana J,Khairina W,Boo N Y,et al.Reducing hypothermia in preterm infants with polyethylene wrap[J].Pediatr Int,2011,53(4):468-474.
[18]周微.极低出生体重儿发生入院低体温的危险因素分析及塑料薄膜封闭式包裹对早产儿入院体温的影响[D].温州:温州医科大学,2009.
[19]Shabeer MP,Abiramalatha T,Devakirubai D,et al.Standard care with plastic bag or portable thermal nest to prevent hypothermia at birth:a three-armed randomized controlled trial[J].J Perinatol,2018,38(10):1324-1330.
[20]Nimbalkar SM,Khanna AK,Patel DV,et al.Efficacy of polyethylene skin wrapping in preventing hypothermia in preterm neonates(<34 weeks):a parallel group non-blinded randomized control trial[J].J Trop Pediatr,2018,20(3):22-26.
[21]Talakoub S,Shahbazifard Z,Armanian AM,et al.Effect of two polyethylene covers in prevention of hypothermia among premature neonates[J].Iran J Nurs Midwifery Res,2015,20(3):322-326.
[22]Vohra S,Frent G,Campbell V,et al.Effect of polyethylene occlusive skin wrapping on heat loss in very low birth weight infants at delivery:a randomized trial[J].J Pediatr,1999,134(5):547-551.
[23]Vohra S,Roberts RS,Zhang B,et al.Heat loss prevention(He LP)in the delivery room:a randomized controlled trial of polyethylene occlusive skin wrapping in very preterm infants[J].J Pediatr,2004,145(6):750-753.
[24]郑园园,叶旭萍,王晓,等.塑料薄膜包裹转运法对早产儿体温影响的研究[J].护理管理杂志,2016,16(4):294-296.
[25]Raman S,Shahla A.Temperature drop in normal term newborn infants born at the University Hospital,Kuala Lumpur[J].Aust N Z J Obstet Gynaecol,1992,32(2):117-119.
[26]邢丽云,黄丽华.早产儿保暖措施的研究进展[J].中华护理杂志,2017,52(2):230-233.
[27]Matthew B,Lakshminrusimha S,Cominsky K,et al.Vinyl bags prevent hypothermia at birth in preterm infants[J].Indian JPediatr,2007,74(3):249-253.
[28]Ibrahim CP,Yoxall CW.Use of plastic bags to prevent hypothermia at birth in preterm infants-do they work at lower gestation?[J].Acta Paediatr,2009,98(2):256-260.
[29]Singh A,Duckett J,Newton T,et al.Improving neonatal unit admission temperatures in preterm babies:exothermic mattresses,polythene bags or a traditional approach?[J].J Perinatol,2010,30(1):45-49.
[30]Gunn AJ,Gluckman PD.Should we try to prevent hypothermia after cardiac arrest?[J].Pediatrics,2000,106(3):132-133.
[31]Gunn AJ,Bennet L.Is temperature important in delivery room resuscitation?[J].Semin Neonatol,2001,6(3):241-249.
[32]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011.