Are babies given thermal care (measures to reduce heat loss) less likely to develop neonatal hypoglycaemia?

Keep the baby dry and warm after birth. Prioritise skin-to-skin contact with the mother. [Conditional recommendation]

Low to very low certainty evidence shows skin-to-skin contact may result in a large reduction in hypothermia and neonatal hypoglycaemia and is recommended for all well mother/baby dyads. For very low birthweight (VLBW) babies, low-certainty evidence shows that plastic wrap or a plastic bag can result in a moderate reduction in hypoglycaemia, a large reduction in the duration of the initial hospital stay, and a large reduction in hypothermia upon admission to the NICU, although it may lead to a small increase in hyperthermia on admission. Plastic wrap is readily available and commonly used for keeping VLBW babies warm.

Very low certainty of evidence shows use of a thermal mattress or thermal blanket had little to no effect on hypoglycaemia, and a large reduction in moderate hypothermia on admission to NICU. Thermal mattresses are expensive and lack of evidence of effectiveness means they are not a routine option.

A study on delayed bathing was considered by the Panel to not be relevant to this recommendation.

Consider use of plastic wraps to keep the baby warm when skin-to-skin is not practicable. If a specific neonatal plastic wrap is not available, clingfilm can be used.

Monitor baby’s temperature to avoid hyperthermia.

Studies are needed on:

• The most effective strategies for preventing hypothermia and consequent hypoglycaemia, particularly in term babies and those at risk of hypoglycaemia, and when skin-to-skin is not feasible.

Health equity for Māori

Health professionals must apply this guideline equitably to prevent harm and ensure accountability in implementing recommendations for Māori as part of a pro-equity approach. Pākehā benefit from health system privileges, while Māori face systemic racism, leading to reduced health benefits. Health equity can be improved if Māori receive effective interventions.

Ensure Māori whānau are fully informed about their healthcare options as a part of a mana motuhake (self-determination), including prevention, monitoring and treatment options, health benefits and potential risks. Detailed explanations of all interventions, their necessity, and results should also be provided to help achieve equitable health outcomes. Ensure whānau are provided with information in multiple formats (oral, written, online, video) that align with cultural values.

Whānau living in rural areas may face additional financial costs and barriers to accessing specialist services. Proactively support these whānau by informing and supporting them to access available financial assistance and resources to access specialist services.

Health equity for other groups

Health professionals must apply this guideline equitably to prevent harm. Health equity can be improved if all whānau receive effective interventions.
Many groups, including Pacific, Asian, migrant and rural communities, also face significant health inequities. These groups often encounter barriers such as language difficulties, lower health literacy, and challenges in understanding their healthcare options. It is important that all whānau are fully informed about their healthcare options, including prevention, monitoring and treatment options, health benefits and potential risks. Detailed explanations of all interventions, their necessity, and results should also be provided to help achieve equitable health outcomes. Culturally appropriate communication, use of interpreter services where required, along with the use of multiple formats (oral, written, online, video), can help improve engagement with health services.

Rural communities may also experience additional challenges, such as increased travel costs and limited access to specialist care. Providing proactive support, including information about and assistance to access financial and other resources to help access specialist services, is crucial to reducing these inequities and improving health outcomes. Specific additional issues are addressed under the recommendations and EtDs where relevant.