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Question 1: Is the use of plastic bags for thermoregulation in term neonates effective in preventing hypothermia in a low-resource setting?
  1. Marie Lester1,
  2. Wairimu Kimani2,
  3. Peter Cartledge3
  1. 1Department of Paediatrics, PCEA Chogoria Hospital, Chogoria, Kenya
  2. 2Department of Paediatrics, Aga Khan University Hospital, Nairobi, Kenya
  3. 3Department of Paediatrics, Leeds Children's Hospital, Leeds, UK
  1. Correspondence to Dr Marie Lester, Neonatal Unit, Leeds Children's Hospital, Leeds, UK; marielester{at}

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Clinical bottom line

  • Placing term infants in plastic bags for 1 h at birth reduces rates of hypothermia with an absolute risk reduction of 13% (grade B).1

  • The papers reviewed did not report adequate data on the effect of plastic bag use on subsequent admission rates, hypoglycaemia, respiratory distress or mortality rates.


You are the medical officer in a small rural hospital in Kenya with limited resources. You accept 2000 deliveries each year and have noticed that a high proportion of neonates admitted to your small newborn unit are hypothermic. You suspect this is contributing to their morbidity (hypoglycaemia, respiratory distress) and mortality. You wonder if the use of plastic bags for early thermoregulation in term neonates could be effective at preventing hypothermia.

Structured clinical question

In term neonates in a low-resource setting (patient), does placement in a standard clear plastic bag at birth (intervention) compared with standard thermoregulation (control) reduce rates of hypothermia (primary outcome), admission rates, hypoglycaemia, respiratory distress and death (secondary outcomes).

Search strategy

The Cochrane Library and Pubmed were searched (1946 to current date) on 1 December 2013 using the terms (infant, newborn OR neonate* OR newborn) AND (plastic bag* OR plastics OR polyethylenes). A search of the Cochrane Library (no limits) yielded 223 results, of which 6 were relevant.1–6 Pubmed search results were limited to ‘English-language’, ‘Human Studies’ and ‘Clinical Trial’ and yielded 66 results, 5 of which were relevant.1–5 The reference lists of these articles were reviewed and no additional papers identified. The infants included in one study were preterm (<36 weeks) and subsequently excluded. …

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  • Contributors PC proposed the clinical question. ML and WK completed the literature search. ML completed the first draft which was revised by WK, PC and ML.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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