Thermal management with and without servo-controlled system in preterm infants immediately after birth: a multicentre, randomised controlled study.

<bold>Background: </bold>The thermal servo-controlled systems are routinely used in neonatal intensive care units (NICUs) to accurately manage patient temperature, but their role during the immediate postnatal phase has not been previously assessed.<bold>Objective: </bold>To compare two modalities of thermal management (with and without the use of a servo-controlled system) immediately after birth.<bold>Study Design and Setting: </bold>Multicentre, unblinded, randomised trial conducted 15 Italian tertiary hospitals.<bold>Participants: </bold>Infants with estimated birth weight <1500 g and/or gestational age <30+6 weeks.<bold>Intervention: </bold>Thermal management with or without a thermal servo-controlled system during stabilisation in the delivery room.<bold>Primary Outcome: </bold>Proportion of normothermia at NICU admission (axillary temperature 36.5°C-37.5°C).<bold>Results: </bold>At NICU admission, normothermia was achieved in 89/225 neonates (39.6%) with the thermal servo-controlled system and 95/225 neonates (42.2%) without the thermal servo-controlled system (risk ratio 0.94, 95% CI 0.75 to 1.17). Thermal servo-controlled system was associated with increased mild hypothermia (36°C-36.4°C) (risk ratio 1.48, 95% CI 1.09 to 2.01).<bold>Conclusions: </bold>In very low birthweight infants, thermal management with the servo-controlled system conferred no advantage in maintaining normothermia at NICU admission, while it was associated with increased mild hypothermia. Thermal management of preterm infants immediately after birth remains a challenge.<bold>Trial Registration Number: </bold>NCT03844204. [ABSTRACT FROM AUTHOR]