Than in the control group (P = .

0008) and was comparable with that in the wrap

group (p = .33); 1 hour later, temperature was significantly higher in the cap group
than in the control group (P= .0003) and was comparable with that of the wrap
group (p= .29). Birth weight had a significant effect on temperature at NICU
admission and 1 hour later is reported in Figure 2 (available at www.jpeds.com)
Infant covered with polyethylene caps (43%) and placed in polyethylene bags (62%)
were less likely to have temperature <36.4 C on admission to the NICU than
control infants (90%; Table II).
Two infants in the wrap group had axillary temperature on admission >37.5C).
The the mean delivery to admission time was significantly shorter in the control
group than in wrap group (165 minutes versus 21 7 minutes; P < .01), and the
mean Apgar score at 5 minutes was significantly higher in group in the wrap group
(7.4 1.5 versus 8.1 1.0; P= .03). no differences were found in the group for
mortality rate, presence of major brain injury, 1-minute Apgar score, blood gas
analysis, and serum glucose concentration on NICU admission (Table II).
Optimal thermal treatment of preterm infants is crucial aspect of care because
hypothermia is a frequent problem in very preterm infants that may influence
outcome. 1-5 Three main approaches to therml care of the preterm infants have been
studied in recent years 12-13: occlusive wraping, 5,7,8 transwarmer mattress, 14 and
skin-to skin contact. 15
We assessed whether a polyethylene cap prevents heat loss in very preterm infants
after delivery better than polyethylene occlusive wrapping and conventional drying.
We found that a polyethylene cap is comparable with polyethylene occlusive
wrapping for heat loss prevention after delivery of very preterm infants. Both these
methods provide better thermal protection than conventional drying. For infants
covered with a polyethylene cap, this positive effect was maintained 1 hour after
admission to the NICU. The recent use monitoring device such as oximeters
immediately after birth precludes the use of the body wrap as it was originally
tasted. The use of polyethylene cap is an attractive alternative because is quick and
there is fill access to the body for monitoring and insertion of lines.
Earlier randomized clinical trials demonstrated that occlusive polyethylene and
polyurethane wraps are more effective than conventional drying in preventing heat
loss in very preterm infants immediately after birth. 5,7,8 in these studies, the infants
head was dried and left uncovered7,8 or covered with a cotton cap. 5 the method
consisting of putting the infant inside a polyethylene or polyurethane bag, with the
head protruding from the bag, minimizes heat loss from the trunk, but not heat
losses from the head.
The brain of the newborn infant has high oxygen consumption and generation and
generates as significant amount of the total heat produced. The surface area of the

head represents 20.8% of the total body surface area. 16 Therefore, if the head were
to be insulated by provision of a cap, heat loss should be reduced. 9,11
Tube gauze or stockinet caps are ineffective in preventing heat loss in neonates, 9-11
In a physiological study, stothers calculated that gamgee-lined woolen hats reduced
heat loss by 25% in naked babies. 11 more recently, a study demonstrated that
woolen hats reduced heat loss. 17 All these studies evaluated mostly term infants,
and babies who were born at <32 weeks gestation have not been studied.