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TMR Integrative Nursing  2018, Vol. 2 Issue (3): 132-140    DOI: 10.12032/TMRIN20180717
Efficacy and safety of the heated gel mattress for prevention of hypothermia in preterm infants during intra-hospital transport: a meta-analysis
Ya-Qian Liu1, Meng-Jie Lei1, Ting-Ting Liu1, Yu-Feng Li1, Chu-Yun Cui1, Li-Jia Ni2, Chang-De Jin3()
1Department of Graduate, Tianjin University of Traditional Chinese Medicine, Tianjin, China
2Department of gynaecology and obstetrics, Tianjin Center Obstetrics and Gynecology Hospital, Tianjin, China
3Department of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
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This study evaluated the efficacy and safety of the heated gel mattress for prevention of heat loss on preterm infants with hypothermia during the transport systematically and objectively.

Editor’s Summary

Premature baby's hypothermia will cause short-term as well as long-term morbidities, including oxygen consumption, sepsis, early retinopathy and intraventricular hemorrhage. Therefore, implementation of early intervention strategies is vitally essential to prevent premature hypothermia.


Objective: To evaluate the efficacy and safety of the heated gel mattress for prevention of heat loss on preterm infants with hypothermia during the transport systematically and objectively. Methods: Systematic searches on PubMed, EMBASE, Cochrane Library, Web of Science, CBM, CNKI, Wanfang and VIP were performed for randomized controlled trials (RCTs) or quasi-RCTs which explored the effects of heated gel mattress on prevention of hypothermia in premature infants relative to conventional alternatives. Studies were screened according to inclusion and exclusion criteria, extracted data and assessed quality. Then, meta-analysis and trial sequential analysis were performed by RevMan 5.3 and TSA v0.9 software developed at the Copenhagen Clinical Trials Center in Denmark, independently. Results: This systematic review included 10 studies which comprised 7 RCTs and 3 quasi-RCTs, encompassing 773 patients. The results of meta-analysis showed that in heated gel mattress group admission temperature on neonatal intensive care unit (SMD, 0.63; 95% CI, 0.40 to 0.87; P = 0.00), incidence of hypothermia (RR, 0.73; 95% CI, 0.57 to 0.93; P = 0.01) and hyperthermia (RR, 1.82; 95% CI, 1.31 to 2.54l P = 0.00) compared with the control group had significantly statistical difference; however, there was no significant difference in admission temperature on exothermic mattresses or TransWarmer mattress group, mortality, sepsis, retinopathy of prematurity, intraventricular hemorrhage III/IV between two groups. trial sequential analysis confirmed that the pooled results of admission temperature on neonatal intensive care unit and hyperthermia were stable and reliable; but the combination of low-temperature incidence and mortality indicators suggested that the sample size was insufficient. Conclusion: Heated gel mattress is a safe and effective rewarming intervention that can improve body temperature of hypothermic preterm infants during transport, reduce the incidence of hypothermia and does not increase the incidence of morbidity and complications. However, it is recommended that clinical monitoring of body temperature should be performed dynamically to decrease the potential risk of high fever. In addition, due to the limitation of quantity and quality of included studies, its cost-effectiveness and far-reaching influence on long-term follow-up outcomes need further evaluation through clinical multicenter, large sample, and high-quality research.

Key wordsPremature infants      Hypothermia      Intra-hospital transport      Temperature management      Meta-analysis      Trial sequential analysis     
Published: 24 September 2018
Cite this article:

Ya-Qian Liu, Meng-Jie Lei, Ting-Ting Liu, Yu-Feng Li, Chu-Yun Cui, Li-Jia Ni, Chang-De Jin. Efficacy and safety of the heated gel mattress for prevention of hypothermia in preterm infants during intra-hospital transport: a meta-analysis. TMR Integrative Nursing, 2018, 2(3): 132-140.

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Figure 1 Flow diagram of included and excluded studies.
Study Country Design SS Gestation
(weeks, T/C)
BW (g) Intervention Definition of hypothermia Outcomes Attrition (%)
Ethiopia RCT 67 33.3 ± 3.4/
34.9 ± 2.9
1000-1500 HGM RC Core temperature < 35.0°C abc 5(7%)
Almeida 2009[16] Hawaii QRCT 115 26.0±2.3/
<1500 TWM RW Body temperature < 36.3°C ab 0
India RCT 160 35.7±0.2/
1300-2500 HGM RC Axillary temperature 36.0°C - 36.4°C abc 3(3%)
Ireland QRCT 43 29.0±1.0/
750-1500 EM RC Axillary temperature < 36.5°C abcg 0
Ireland RCT 72 28.0±2.0/
<1500 EM RC Rectal temperature abc 0
Chawla 2011[20] US QRCT 102 28.7±3.0/
750-1500 TWM RC Axillary temperature < 36.0°C abdfg 0
Australia RCT 74 29.0±2.3/
1300-1500 HGM INC Axillary temperature abcd 0
Mathew 2013[22] New York RCT 41 26.0±1.2/
750-1000 TWM PB Axillary temperature adefg 0
Sarman 1989[23] Turkey RCT 60 31.5±3.5/
1000-2000 HGM INC Rectal temperature ≤ 34℃ ag 0
US RCT 39 26.0±1.2/
<1300 EM RC Axillary temperature < 36.5°C adefg 1(2%)
Table 1 Characteristics of included studies
Figure 2 Risk of bias summary and graph.
Figure 3 Subgroup analysis of the HGM (different type of rewarming mattress) in admission temperature on NICU of preterm infants. NICU, Neonatal intensive care unit; HGM, Heated gel mattress
Figure 4 Forest plot showing the effect of the HGM on incidence of hypothermia of preterm infants
Figure 5 Forest plot showing the effect of the HGM on incidence of hyperthermia of preterm infants
Figure 6 Forest plot showing the effect of the HGM on mortality rate of preterm infants
Figure 7 Forest plot showing the effect of the HGM on incidence of complications of preterm infants
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