Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Embrace versus Cloth Wrap in preventing neonatal hypothermia during transport: a randomized trial

Journal of Perinatology volume 41, pages 330–338 (2021)Cite this article

Subjects

Abstract

Background

We assessed the efficacy of Embrace Nest Infant Warmer versus Cloth Wrap in preventing hypothermia during short-term transport from the emergency department (ED) to the neonatal intensive care unit (NICU).

Methods

Neonates weighing ≥1500 g coming to the ED were randomized for transport to the NICU. Axillary temperature was measured.

Results

A total of 120 newborns (60 per group) were enrolled. From ED exit to NICU entry, the mean (SD) temperature increased in the Embrace group by 0.37 °C (0.54), whereas it reduced by 0.38 °C (0.80) in the Cloth group (p < 0.001). Hypothermia cases reduced in the Embrace group from 39 (65%) to 21 (35%), while it increased from 21 (35%) to 39 (65%) in the Cloth group (p = 0.001) from ED exit to NICU entry. The thermoregulation for 24 h after admission to the NICU was superior in the Embrace group.

Conclusions

Embrace showed significantly better thermoregulation in neonates. Further studies should be done to measure its effectiveness in different environments and distances.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Features of Embrace Nest Infant Warmer.
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. World Health Organization. Thermal protection of the newborn: a practical guide. Maternal and safe motherhood programme. 1997. p. 1–67.

  2. Lunze K, Bloom DE, Jamison DT, Hamer DH. The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival. BMC Med. 2013;11:24.

    Article  Google Scholar 

  3. Agarwal S, Sethi V, Srivastava K, Jha P, Baqui AH. Human touch to detect hypothermia in neonates in Indian slum dwellings. Indian J Pediatr. 2010;77:759–62.

    Article  Google Scholar 

  4. Nimbalkar SM, Patel VK, Patel DV, Nimbalkar AS, Sethi A, Phatak A. Effect of early skin-to-skin contact following normal delivery on incidence of hypothermia in neonates more than 1800 g: randomized control trial. J Perinatol. 2014;34:364–8.

    Article  CAS  Google Scholar 

  5. Million Death Study Collaborators. Causes of neonatal and child mortality in India: a nationally representative mortality survey. Lancet. 2010;376:1853–60.

  6. Urubuto F, Agaba F, Choi J, Dusabimana R, Teteli R, Kumwami M, et al. Prevalence, risk factors and outcomes of neonatal hypothermia at admission at a tertiary neonatal unit, Kigali, Rwanda—a cross-sectional study. J Matern Fetal Neonatal Med. 2019;e-pub ahead of print 15 October 2019;1–8. https://doi.org/10.1080/14767058.2019.1671334.

  7. Mullany LC, Katz J, Khatry SK, LeClerq SC, Darmstadt GL, Tielsch JM. Neonatal hypothermia and associated risk factors among newborns of southern Nepal. BMC Med. 2010;8:43.

    Article  Google Scholar 

  8. Laptook AR, Salhab W, Bhaskar B, Neonatal Research Network. Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics. 2007;119:e643–9.

  9. Soll RF. Heat loss prevention in neonates. J Perinatol. 2008;28:S57–9.

    Article  Google Scholar 

  10. Conde-Agudelo A, Díaz-Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 2016 (8): CD002771.

  11. McCall EM, Alderdice F, Halliday HL, Vohra S, Johnston L. Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2018:CD004210.

  12. Embrace Innovations. https://www.embraceinnovations.com/. Accessed 5 March 2020.

  13. Embrace—Design for Extreme Affordability. https://extreme.stanford.edu/projects/embrace/. Accessed 6 March 2020.

  14. Satia J, Misra M, Arora R, Neogi S, editors. Innovations in maternal health: case studies from India. India: SAGE Publications; 2013.

  15. How to use the Embrace Nest infant warmer. https://www.youtube.com/watch?v=8T_alDdmPyY. Accessed 9 March 2020.

  16. Bhat SR, Meng NF, Kumar K, Nagesh KN, Kawale A, Bhutani VK. Keeping babies warm: a non-inferiority trial of a conductive thermal mattress. Arch Dis Child Fetal Neonatal Ed. 2015;100:309–12.

    Article  Google Scholar 

  17. Nimbalkar S, Patel H, Dongara A, Patel DV, Bansal S. Usage of EMBRACETM in Gujarat, India: survey of paediatricians. Adv Prev Med. 2014;2014:1–5.

    Article  Google Scholar 

  18. Nimbalkar SM, Khanna AK, Patel DV, Nimbalkar AS. Efficacy of polyethylene skin wrapping in preventing hypothermia in preterm neonates (<34 Weeks): a parallel group non-blinded randomized control trial. J Trop Pediatr. 2019;65:122–9.

    Article  Google Scholar 

  19. Aylott M. The neonatal energy triangle. Part2: thermoregulatory and respiratory adaption. Paediatr Nurs. 2006;18:38–42.

    PubMed  Google Scholar 

  20. Kumar V, Shearer JC, Kumar A, Darmstadt GL. Neonatal hypothermia in low resource settings: a review. J Perinatol. 2009;29:401–12.

    Article  CAS  Google Scholar 

  21. Interprofessional Education and Research Committe. Newborn Thermoregulation. Champlain Matern Newborn Reg Progr. 2013. p. 1–16.

  22. Baumgart S. Iatrogenic hyperthermia and hypothermia in the neonate. Clin Perinatol. 2008;35:183–97.

    Article  Google Scholar 

  23. Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, De Bernis L. Evidence-based, cost-effective interventions: How many newborn babies can we save? Lancet. 2005;365:977–88.

    Article  Google Scholar 

  24. Musialik-Swietlińska E, Bober K, Swietliński J, Górny J, Krawczyk R, Owsianka-Podleśny T. Evaluation of sick neonates’ medical interventions in maternity units before transport to reference centres. Med Wieku Rozwojowego. 2011;15:84–90.

    Google Scholar 

  25. Chandrashekhar C, Doreswamy S, Nataraj N, Panachiyil G, Babu T. Transport of sick neonates to a tertiary care hospital: condition at arrival and outcomes. J Neonatol. 2019;33:283–4.

    Article  Google Scholar 

  26. Rathod D, Adhisivam B, Bhat BV. Transport of sick neonates to a tertiary care hospital, South India: condition at arrival and outcome. Trop Doct. 2015;45:96–9.

    Article  Google Scholar 

  27. Arora P, Bajaj M, Natarajan G, Arora NP, Kalra VK, Zidan M. et al. Impact of interhospital transport on the physiologic status of very low-birth-weight infants. Am J Perinatol. 2014;31:237–44.

    PubMed  Google Scholar 

  28. Hodson WA. Temperature regulation. In: Gleason CA, Juul SE, editors. Avery’s diseases of the newborn.10th ed. Philadelphia, PA: Elsevier; 2018.

  29. May L, Nshimyiryo A, Kubwimana M, Nahimana E, Schoen N, Gadgil A, et al. Performance of a nonelectric infant warmer in Rwandan health centers. Glob Pediatr Health. 2019;6:1-10. 2333794X19884820. https://doi.org/10.1177/2333794X19884820

  30. Mekonnen AG, Yehualashet SS, Bayleyegn AD. The effects of kangaroo mother care on the time to breastfeeding initiation among preterm and LBW infants: a meta-analysis of published studies. Int Breastfeed J. 2019;14:12.

    Article  Google Scholar 

  31. Buch PM, Makwana AM, Chudasama RK, Doshi SK. Status of newborn transport in periphery and risk factors of neonatal mortality among referred newborns. J Pharm Biomed Sci. 2012;16:1–6.

    Google Scholar 

  32. Bellini C, De Biasi M, Gente M, Ramenghi LA, Aufieri R, Minghetti D. et al. Rethinking the neonatal transport ground ambulance. Ital J Pediatr. 2019;45:1–7.

    Article  Google Scholar 

  33. Meyer MP, Payton MJ, Salmon A, Hutchinson C, De Klerk A. A clinical comparison of radiant warmer and incubator care for preterm infants from birth to 1800 grams. Pediatrics. 2001;108:395–401.

    Article  CAS  Google Scholar 

  34. Saluja S, Malviya M, Garg P, Gupta G, Jain N. Transport of a sick neonate. Evidence based clinical practice guidelines. India: National Neonatology Forum; 2010.

  35. 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 Perinatol. 2016;36:83–9.

    Article  Google Scholar 

Download references

Acknowledgements

Dr. Amee Amin, MD, from Charleston Area Medical Center/West Virginia University helped to check language.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Deenanath Mangeshkar Hospital, Pune, India

    Vallaree Anant Morgaonkar

  2. Department of Pediatrics, Pramukhswami Medical College, Karamsad, India

    Dipen Vasudev Patel & Somashekhar Marutirao Nimbalkar

  3. Central Research Services, Charutar Arogya Mandal, Karamsad, India

    Ajay Gajanan Phatak

  4. Department of Physiology, Pramukhswami Medical College, Karamsad, India

    Archana Somashekhar Nimbalkar

Authors
  1. Vallaree Anant Morgaonkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dipen Vasudev Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ajay Gajanan Phatak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Archana Somashekhar Nimbalkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Somashekhar Marutirao Nimbalkar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VAM and DVP conceptualized and designed the study, drafted the initial paper, reviewed and revised the paper. AGP designed the data collection instruments, collected data, carried out the initial analyses and reviewed and revised the paper. ASN and SMN conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the paper for important intellectual content. All authors approved the final paper as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Dipen Vasudev Patel.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morgaonkar, V.A., Patel, D.V., Phatak, A.G. et al. Embrace versus Cloth Wrap in preventing neonatal hypothermia during transport: a randomized trial. J Perinatol 41, 330–338 (2021). https://doi.org/10.1038/s41372-020-0734-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-020-0734-x

This article is cited by

Search

Advanced search

Quick links