Is temperature important in delivery room resuscitation?

The possibility that temperature may affect the outcome of resuscitation from severe perinatal asphyxia has been a long-standing focus of research. Experimentally it is now well established that even small changes in temperature during severe hypoxia-ischemia critically modulate outcome. Clinical and experimental studies have now shown that hypoxic-ischemic injury continues to evolve after resuscitation. Experimentally, prolonged mild to moderate hypothermia can dramatically reduce this delayed injury, while mild hyperthermia over the same period worsens injury. Indeed there are data indicating that moderate post-ischemic hyperthermia can be deleterious as late as 24 h after reperfusion. Hypothermia has significant potential adverse effects, and at present its clinical use is restricted to large randomized controlled trials. The present paper reviews evidence suggesting that both primary prevention of maternal pyrexia during labour, and secondary prevention of hyperthermia after neonatal resuscitation, have the potential to significantly reduce the consequences of perinatal hypoxia-ischemia.