Portal de Periódicos da CAPES

In Response

2015; Lippincott Williams & Wilkins; Volume: 120; Issue: 6 Linguagem: Inglês

10.1213/ane.0000000000000754

1526-7598

Ernst-Peter Horn, Berthold Bein, Jan Höcker,

Respiratory Support and Mechanisms

Vilinsky and McCaul1 raise several important questions about our recently published article on neonatal warming after cesarean delivery. We agree that hypothermia in neonates born by cesarean delivery is a serious problem, and research data, especially from randomized trials, are scarce. We also agree that overheating of newborns has to be avoided. In our study, core temperature in actively warmed neonates decreased from 37.5°C ± 0.2°C at birth to 37.0°C ± 0.2°C after 20 minutes of bonding. By using the forced-air device set to 44°C, air temperature was safe. Mothers and neonates tolerated the procedure well. None of the 19 neonates showed overheating (Table 1). Core temperature was not higher in any newborn at any time during bonding or later when compared with their birth temperature. These results are consistent with the practical experiences in our department, where during a period of 10 years, any mature neonate born by cesarean delivery was actively warmed using the described procedure. None of the >3000 neonates showed signs of overheating.Table 1: Rectal Temperature of All Newborns Receiving Forced-Air Warming at Birth and After 10 and 20 Minutes of BondingForced-air warming is recommended by guidelines for adults, children, and infants as an efficient and safe method to prevent perioperative hypothermia.2,3 Guidelines recommend operating room temperatures of not <21°C for adults and 24°C for children. Temperatures near 30°C to 33°C are required to reduce the incidence of hypothermia in children. Such high room temperatures are typically not accepted by surgeons and are neither effective nor practical for protecting neonates from hypothermia during bonding after cesarean delivery. Both scientific evidence and practical experiences suggest anesthesiologists should prevent neonates and their mothers from hypothermia using forced-air warming. This limits the severe risks of hypothermia. Although overheating of the newborn has not been a problem, the risk can be readily assessed using a rectal temperature probe during bonding. Ernst-Peter Horn, MD Department of Anesthesiology and Intensive Care Medicine Regio Klinikum Pinneberg Pinneberg, Germany Berthold Bein, MD Department of Anesthesiology (AE) and Intensive Care Medicine Asklepios Clinic St. Georg Hamburg, Germany Jan Höcker, MD Department of Anesthesiology and Intensive Care Medicine University Hospital Schleswig-Holstein Campus Kiel Kiel, Germany [email protected]