title: The incidence and prevention of hypothermia in newborn bonding after cesarean delivery: a randomized controlled trial.
abstract: BACKGROUND
  Little is known about thermoregulation of the newborn while bonding on the mother's chest immediately after cesarean delivery. Newborn hypothermia is associated with serious complications and should be avoided. Therefore, we evaluated whether newborns develop hypothermia during intraoperative bonding while positioned on their mothers' chests and investigated the effects of active cutaneous warming of the mothers and babies during a 20-minute intraoperative bonding period.
  
  
  METHODS
  We enrolled 40 parturients scheduled for elective cesarean delivery under spinal anesthesia. Mothers and their newborns were randomized to receive either passive insulation or forced-air skin-surface warming during the surgical procedure and bonding period. The primary outcome was neonatal core temperature at the end of the bonding period. Core temperatures of the newborns were measured with a rectal probe. Body temperatures of the mothers were assessed by sublingual measurements. Skin temperatures, thermal comfort of the mothers, and perioperative shivering were evaluated.
  
  
  RESULTS
  Without active warming from the beginning of the surgical procedure until the end of the bonding period, the mean (SD) neonatal core temperature decreased to 35.9 (0.6)°C. Seventeen of 21 (81%) newborns became hypothermic (defined as a core temperature below 36.5°C). Active skin-surface warming from the beginning of the surgical procedure until the end of the bonding period resulted in a neonatal core temperature of 37.0 (0.2)°C and a decreased incidence of hypothermia (1 of 19 (5%) newborns (P < 0.0001)). In addition, active warming increased the mean skin temperatures of the infants, maternal core and skin temperatures, maternal thermal comfort, and reduced perioperative shivering.
  
  
  CONCLUSIONS
  Active forced-air warming of mothers and newborns immediately after cesarean delivery reduces the incidence of infant and maternal hypothermia and maternal shivering, and increases maternal comfort.
authors.affiliation: From the *Departments of Anesthesiology and Intensive Care Medicine, Regio Klinikum Pinneberg, Pinneberg, Germany; †Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; and ‡Department of Gynecology and Obstetrics, Regio Klinikum Pinneberg, Pinneberg, Germany.
authors.forename: Ernst-Peter
authors.initials: EP
authors.lastname: Horn
authors.forename: Berthold
authors.initials: B
authors.lastname: Bein
authors.forename: Markus
authors.initials: M
authors.lastname: Steinfath
authors.forename: Kerstin
authors.initials: K
authors.lastname: Ramaker
authors.forename: Birgit
authors.initials: B
authors.lastname: Buchloh
authors.forename: Jan
authors.initials: J
authors.lastname: Höcker
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D001034:Apgar Score; D001831:Body Temperature / Q000502:physiology; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007035:Hypothermia / Q000453:epidemiology* / Q000517:prevention & control*; D015994:Incidence; D007231:Infant, Newborn; D009769:Object Attachment; D011247:Pregnancy; D017694:Rewarming; D012768:Shivering / Q000502:physiology; D012881:Skin Temperature / Q000502:physiology; D016896:Treatment Outcome