Drying Before Plastic Wrapping Does Not Improve Temperature Control in Very Preterm Infants: JAMA

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Maret 19, 2026 - 23:55

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Drying Before Plastic Wrapping Does Not Improve Temperature Control in Very Preterm Infants: JAMA

Researchers have found in a multicenter randomized trial that drying very preterm infants before plastic wrapping did not improve maintenance of normothermia at NICU admission. Many infants were still outside the normal thermal range, indicating that effective thermal management remains a challenge and requires further study. Deaths observed were attributed to the neonates’ compromised condition rather than the trial interventions.

Despite continuous improvements in neonatal resuscitation and stabilization in the last decades, thermal management immediately after birth remains an unresolved issue in preterm infants. A study was done to compare 2 strategies of thermal management (plastic wrapping with or without drying) for preventing heat loss at birth in very preterm infants. This multicenter, unblinded, randomized clinical trial was conducted among very preterm infants (birth weight <1500 g and/or gestational age ≤30 weeks 6 days) at 21 tertiary care hospitals in Italy from February 21, 2023, to July 18, 2024.

The primary outcome was the proportion of participants with normothermia (36.5-37.5 °C) at admission to the neonatal intensive care unit (NICU). The secondary outcomes included hypothermia (<36.5 °C), moderate to severe hypothermia (<36.0 °C), and hyperthermia (>37.5 °C) at NICU admission, temperature at 1 hour after NICU admission, intraventricular hemorrhage, respiratory distress syndrome, late-onset sepsis, bronchopulmonary dysplasia, and mortality before hospital discharge. Results Overall, 354 very preterm infants were randomized (180 [50.8%] female; mean [SD] gestational age, 28.6 [2.5] weeks); all received the allocated intervention and were included in the analysis. Normothermia at NICU admission was achieved in 81 of 177 dried infants (45.8%) and 82 of 177 undried infants (46.3%; risk ratio, 0.99; 95% CI, 0.79-1.24). The mean (SD) neonatal temperature at NICU admission was 36.4 °C (0.8 °C) in dried neonates and 36.5 °C (0.7 °C) in undried neonates (mean difference, −0.1 °C; 95% CI, −0.2 °C to 0.1 °C). In-hospital mortality included 26 of 177 dried neonates (14.7%) and 10 of 177 undried neonates (5.6%) (unadjusted risk ratio, 2.60; 95% CI, 1.29-5.23). The other secondary outcome measures were not different between the 2 arms.

In this multicenter randomized clinical trial, drying before plastic wrapping provided no benefit to very preterm infants in maintaining normothermia at NICU admission. Most deaths could be expected due to the compromised profile of the neonates, with no pathophysiological explanation related to the trial interventions. Approximately half of the infants were outside the normal thermal range at NICU admission; hence, thermal management remains a challenge requiring further investigations.

Reference:

Cavallin F, Doglioni N, Risso FM, et al. Drying Very Preterm Infants Before Plastic Wrapping at Birth: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(3):e2556902. doi:10.1001/jamanetworkopen.2025.56902

Keywords:

Drying, Before, Plastic, Wrapping, Improve, Temperature , Control, Preterm Infants, JAMA

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