JOURNAL CLUB · ARTICLE OF THE WEEK
Drying Very Preterm Infants Before Plastic Wrapping at Birth
Cavallin F, Doglioni N, Risso FM, et al. JAMA Network Open. 2026;9(3):e2556902. The NEODRY multicentre randomised clinical trial.
DRYING BEFORE
WRAPPING
No improvement in normothermia
Normothermia at NICU admission 45.8% (dried) vs 46.3% (not dried); RR 0.99 (95% CI 0.79-1.24).
Temperatures essentially identical
Mean admission temperature 36.4°C vs 36.5°C (difference -0.1°C).
Higher mortality in the drying arm
In-hospital death 14.7% vs 5.6%; adjusted RR 2.71 (1.31-5.62). The authors found no mechanism and suggest it may be chance, but it warrants caution.
Half of all infants were cold
About 50% were outside the normal thermal range at admission, regardless of group.
💡WHY THIS MATTERS
- Hypothermia at NICU admission stays common in very preterm infants despite thermal bundles (~40% in registries)
- Guidelines advise wrapping very preterm infants immediately without drying; drying is only recommended above 32 weeks
- This trial tested whether adding drying before wrapping would further reduce heat loss
- It is the first large RCT of drying-before-wrapping in very preterm infants
- The findings argue against adding this step
✅STRENGTHS
- First large multicentre RCT of this question in very preterm infants
- 354 infants across 21 centres; intention-to-treat with no loss to follow-up
- Prespecified interim analysis and multiple sensitivity analyses
- Pragmatic, real-world delivery-room setting
⚠️LIMITATIONS
- Unblinded in the delivery room (the intervention cannot be masked)
- Single-country (Italy); high caesarean rate, low delayed cord clamping, limited mattress/heated-gas use - may limit generalisability
- No post-discharge or neurodevelopmental follow-up
- The mortality difference has no clear mechanism and may be chance - but cannot be dismissed
- ~Half of infants still cold suggests the wider bundle, not drying, is where gains lie
Practice implications
This trial supports current practice of wrapping very preterm infants immediately without drying - there is no thermoregulation benefit to adding a drying step. Thermal gains are more likely to come from strengthening the rest of the bundle (room temperature, prewarmed mattress, heated humidified gases, hat, checklists), since about half of infants were still cold at admission. The unexplained mortality signal in the drying arm warrants caution pending further data.
Does this change anything about how you manage thermoregulation of very preterm infants at birth?
How should we interpret a statistically significant mortality difference the authors believe may be chance?
Half of infants were still cold - which parts of the thermal bundle would you strengthen?
How generalisable are these Italian findings to your unit?
Take-home message: In very preterm infants, drying before plastic wrapping at birth did not improve normothermia at NICU admission compared with wrapping without drying - supporting current guidance to wrap immediately without drying. About half of infants were still outside the normal thermal range, so the gains lie elsewhere in the thermal bundle. A higher mortality rate in the drying arm was unexplained and may be chance, but warrants caution and further study.
For educational purposes only. Journal club appraisal - figures paraphrased from the published open-access trial; read the full article for complete data. Always align management to current ANZCOR/NRP guidelines and your local SCN/NICU or NETS protocols.