Efficacy of cloth-to-cloth contact versus conventional care in thermoregulation of term newborns: an open-label randomized controlled trial

Neonatal hypothermia is a major contributor to morbidity and mortality in low- and middle-income countries (LMICs). While effective in reducing hypothermia, implementation of skin-to-skin contact (SSC) is often hindered by its privacy concerns. This study aimed to evaluate the efficacy and feasibility of cloth-to-cloth contact (CCC) as an alternative to SSC in term newborns at postnatal ward, where the newborn is dressed and placed in the kangaroo position on the mother's chest without exposing her bare skin. In this randomized trial, stable term newborns in a postnatal ward were assigned to either conventional care (dressed, kept beside the mother) or CCC (dressed, held in kangaroo position with both mother and baby clothed). Axillary temperatures were recorded up to 48 hours of life, and mothers' experiences with CCC were assessed using a structured questionnaire. Eighty-seven neonates were enrolled (43 conventional care, 44 CCC), with 369 and 379 temperature recordings, respectively. Mean axillary temperatures were similar between groups up to 42 hours. At 48 hours, the CCC group had a significantly higher mean temperature [36.85 (0.26)°C] than the conventional care group [36.73 (0.28)° C] (P = .04). The overall incidence of hypothermia was comparable, except in winter, when it was higher in the conventional care group (35.2%) than in the CCC group (22.8%) (P = .008). Most mothers found CCC feasible and preferred it over conventional care. CCC is an effective and feasible intervention for preventing hypothermia in term newborns, especially during colder months in LMIC settings.