title: Initial respiratory support with cold, dry gas versus heated humidified gas and admission temperature of preterm infants.
abstract: OBJECTIVE
  To assess whether the addition of heated humidified gas (HHG) at delivery and until neonatal unit arrival improved admission temperatures of preterm infants.
  
  
  METHODS
  This multicenter, randomized controlled trial was performed in New Zealand and The Netherlands. Infants <32 weeks' gestation who required respiratory support after delivery were randomized to either cold, dry gas or HHG from birth. Standard measures to prevent hypothermia included heated delivery rooms, the use of radiant warmers, body wrap, and head covering. The primary outcome was axillary temperature in the normothermic (36.5-37.5°C) range on admission to a neonatal intensive care unit. Secondary outcomes were measures of respiratory support and neonatal morbidities. The effect of humidification was analyzed by the use of logistic regression.
  
  
  RESULTS
  Of 203 randomized infants, 100 received HHG (humidifier set to 37°C) and 103 received cold, dry gas. In the HHG group, 69 (69%) were normothermic compared with 57 (55%) in the cold, dry gas group (unadjusted OR 1.8, 95% CI 1.01-3.19). A greater number of infants <28 weeks were normothermic on admission in the HHG group (24/35; ie, 69%) compared with the cold, dry gas group (16/38; ie, 42%; P = .03). In addition, 2 (2%) infants in the HHG group had admission temperatures <35.5°C compared with 12 (12%) in the cold, dry gas group (P = .007). Respiratory and short-term outcomes were not different.
  
  
  CONCLUSIONS
  Adding HHG during respiratory support in preterm infants from birth increased the incidence of normothermia at admission.
authors.affiliation: KidzFirst Neonatal Unit, Middlemore Hospital, Auckland, New Zealand; Department of Pediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand. Electronic address: mmeyer@middlemore.co.nz.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Meyer
authors.affiliation: KidzFirst Neonatal Unit, Middlemore Hospital, Auckland, New Zealand; Department of Pediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
authors.forename: David
authors.initials: D
authors.lastname: Hou
authors.affiliation: KidzFirst Neonatal Unit, Middlemore Hospital, Auckland, New Zealand.
authors.forename: Nazmul N
authors.initials: NN
authors.lastname: Ishrar
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Dito
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arjan B
authors.initials: AB
authors.lastname: te Pas
mesh_terms: D001831:Body Temperature; D003080:Cold Temperature; D005260:Female; D005740:Gases / Q000008:administration & dosage; D006358:Hot Temperature; D006801:Humans; D006813:Humidity; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010343:Patient Admission; D012121:Respiration, Artificial / Q000379:methods*
chemical_list: D005740:Gases