ABSTRACT

Background : World Health Organization guidelines recommend to cover the head during kangaroo mother care (KMC), but the effect of a cap on neonatal thermal control during KMC remains to be defined.

Objective: To assess the effectiveness and safety of a woolen cap in maintaining low-birth-weight infants (LBWI) in normal thermal range during KMC.

Methods: Three hundred LBWI candidates for KMC in three African hospitals were randomly assigned to KMC with (CAP) or without (NOCAP) woolen cap in a 1:1 ratio during the first week following birth. Axillary temperature was measured every 6 hours per day. Maternal and room temperature and adherence to skin-to-skin contact were registered at the same time-points.

Results: A total number of 5064 measurements were recorded (median 19 measurements per subject, IQR 10-25). Mean time spent in normal temperature range was 55% (SD 24) in CAP and 56% (SD 24) in NOCAP groups. Multivariable analysis estimated a rate ratio of 0.92 (95% C.I. 0.84 to 1.00; p=0.06) for the effect of the cap vs. no-cap on time spent in normal temperature range.

Conclusions: In these three African low-resource settings and so many days post birth, the use of a woolen cap was safe but provided no advantages in maintaining LBWI in the normal thermal range during being in a KMC ward. LBWI spent only half of the time in the normal temperature range despite warm rooms and skin-to-skin contact. Maintaining normothermia in LBWI remains an unfinished challenge in low-resource settings.