Intervention Review

Radiant warmers versus incubators for regulating body temperature in newborn infants

  1. Vicki Flenady1,*,
  2. Paul G Woodgate2

Editorial Group: Cochrane Neonatal Group

Published Online: 20 OCT 2003

Assessed as up-to-date: 12 JAN 2005

DOI: 10.1002/14651858.CD000435


How to Cite

Flenady V, Woodgate PG. Radiant warmers versus incubators for regulating body temperature in newborn infants. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD000435. DOI: 10.1002/14651858.CD000435.

Author Information

  1. 1

    Mater Health Services, Mater Mother's Research Centre, Wooloongabba, Queensland, Australia

  2. 2

    Mater Mothers' Hospital, Dept of Neonatology, South Brisbane, Queensland, Australia

*Vicki Flenady, Mater Mother's Research Centre, Mater Health Services, Level 2 Quarters Building, Annerley Road, Wooloongabba, Queensland, 4102, Australia. vicki.flenady@mater.org.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 OCT 2003

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The provision of a thermoneutral environment is an essential component of the immediate and longer term care of newborn infants. A variety of methods are currently employed including incubators and open-care systems, with or without modifications such as heat shields and plastic wrap. The system used must allow ready access to the infant but should also minimise alterations in the immediate environment.

Objectives

To assess the effects of radiant warmers versus incubators on neonatal fluid and electrolyte balance, morbidity and mortality.

Search methods

The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of electronic databases: Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2005), MEDLINE (1966 -2005), and CINAHL (1982-2005), previous reviews including cross references, abstracts, conferences, symposia proceedings, expert informants and journal hand searching mainly in the English language.

Selection criteria

Randomised or quasi-randomised trials in which radiant warmers were compared to incubators in a neonatal population.

Data collection and analysis

Independent data extraction and quality assessment of included trials was conducted by the authors. Data were analysed using relative risk (RR) and weighted mean difference (WMD). Results are presented with 95% confidence intervals. Meta-analysis was undertaken using a fixed effect model.

Main results

Eight studies are included in this review; six employed a crossover design. In the overall comparison of radiant warmers vs incubators, radiant warmers caused a statistically significant increase in insensible water loss (IWL) [WMD 0.94g/Kg/day (95% CI 0.47, 1.41)] and a trend towards increased oxygen consumption which was not statistically significant [WMD 0.27mL/kg/min (95% CI -0.09, 0.63)]. Due to small numbers, effects on important clinical outcomes could not be adequately assessed. A comparison of radiant warmers with heat shields vs incubators without heat shields showed a trend for increased IWL in the radiant warmer group, which was not statistically significant. No difference was shown in oxygen consumption.

Authors' conclusions

Radiant warmers result in increased IWL compared to incubators. This needs to be taken into account when calculating daily fluid requirements. The results of this review do not provide sufficient evidence concerning effects on important outcomes to guide clinical practice. Further randomised controlled trials are required to assess the effects of radiant warmers versus incubators in neonatal care on important short and long term outcomes, with particular attention to extremely low birthweight infants in the early neonatal period.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Radiant warmers versus incubators for regulating body temperature in newborn infants

Not enough evidence to show the effects of radiant warmers versus incubators for regulating body temperature in newborn babies.

Low birthweight babies have a higher chance of survival if they are kept warm. Incubators have been used for some time to maintain body temperature. More recently, open cots with an overhead radiant warmer have also been used for babies needing intensive care.
The review of trials found that radiant warmers increase water loss in low birthweight babies in the newborn period when compared to incubators and that this water loss needs to be taken into account when daily fluid requirements are calculated. However, there was not enough information available for this review to enable assessment of other important effects of radiant warmers. Therefore, at the present time, it is not clear which method of maintaining body temperature is best for newborn babies - radiant warmers or incubators. More research is necessary.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

輻射加溫器與保溫箱對於調節新生兒體溫之比較

對於新生嬰兒之立即及長期照護而言,熱中性環境之提供皆是極為重要的一部份。各種不同之方法皆為目前所用,包括保溫箱及開放式照護系統,其可能有或沒有修正裝置,例如隔熱板及塑膠罩。所用之系統應要能夠容許輕易接近處理嬰兒,但亦應要使周圍環境之變化降至最低。

目標

評估輻射加溫器相較於保溫箱對新生兒之水分及電解質平衡、罹病率及死亡率的效應。

搜尋策略

利用Cochrane Neonatal Review Group的標準搜尋策略,包含搜尋電子資料庫: Oxford Database of Perinatal Trials、Cochrane Central Register of Controlled Trials (CENTRAL, Cochrane Library, Issue 1, 2005) 、MEDLINE (1966年2005年) ,以及CINAHL (1982年2005年) 、先前的文獻回顧,包括交叉對照參考資料、摘要、研討會及座談會手冊、專家資訊,及人工搜尋以英文為主之期刊。

選擇標準

其中針對新生兒組群比較輻射加溫器與保溫箱之隨機或半隨機對照試驗。

資料收集與分析

由各個作者針對收錄之試驗獨立進行數據摘錄及品質評估。使用相對風險 (relative risk;RR) 及加權平均差 (weighted mean difference;WMD) 分析數據。結果結合95% 信賴區間 (95% CI) 表示。整合分析係使用固定效果模型進行。

主要結論

本回顧共收錄8項試驗;其中6項使用交叉設計。在輻射加溫器相對於保溫箱之整體比較中,輻射加溫器在統計學上有意義地有較多無感覺性水份流失 (insensible water loss;IWL) [WMD 0.94公克/公斤/天 (95% CI 0.47, 1.41)],並且有氧氣消耗量增加之傾向[WMD 0.27毫升/公斤/分鐘 (95% CI −0.09, 0.63)],但不具統計學上之意義。由於樣本數量過少,茲無法適當評估其對重要臨床結果之效應。其中1項針對具有隔熱板之輻射加溫器與無隔熱板之保溫箱所進行的比較中,其顯示輻射加溫器組具有IWL增加之傾向,但其不具統計學上之意義。在氧氣消耗量方面並未顯示具有差異。

作者結論

相較於保溫箱,輻射加溫器會造成較高之IWL。在計算每日水分需求量時必須將此情形納入考量。本回顧之結果並未提供足夠證據說明其對重要結果之效應以指引臨床實施。仍需要進一步之隨機對照試驗以評估輻射加溫器相較於保溫箱在新生兒照護中對於重要之短期及長期結果的效應,特別須關注其對於極低出生體重之嬰兒在出生後早期的影響。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

並無足夠之證據可顯示輻射加溫器與保溫箱對於調節新生兒體溫之效應的比較。如使其保持溫暖,低出生體重之嬰兒會具有較高之存活機率。長期以來,其係用保溫箱來維持體溫。近來則有針對需要重症加護之嬰兒使用頂上具有輻射加溫器之開放式嬰兒床。本試驗回顧發現,相較於保溫箱,輻射加溫器會增加低出生體重嬰兒在新生兒時期之水分流失,而此種水分流失情形在計算每日水分需求量時必須納入考量。然而,本回顧並無法取得足夠之資訊來評估輻射加溫器的其他重要效應。因此目前仍不清楚,就輻射加溫器或保溫箱而論,何種維持體溫之方法係對新生兒為最佳者。仍需要進一步之研究。