Applied physiology: Temperature control in the newborn infant

SummaryIt has been known for centuries that warmth is important for the newborn. In the 1950s, randomized controlled trials showed that keeping babies warm significantly reduced neonatal mortality. Technology has improved our ability to keep even the most immature baby warm, but there is evidence that infants still become cold during resuscitation and that most units are not achieving the British Association of Perinatal Medicine/Royal College of Paediatrics and Child Health standard of an admission temperature of at least 36 °C. A low temperature on admission has been independently associated with increased mortality in the preterm infant. Preventing evaporation, with the use of a plastic bag, while the baby is on the resuscitaire can abolish hypothermia on admission. There are no studies that show any difference in outcome for preterm babies nursed in incubators compared with those under radiant heaters. Care must be taken to reduce the very high transepidermal water losses under radiant heaters. The way a baby interacts with its environment is always changing and, whatever temperature and humidity settings are first used, it is necessary to monitor the thermal balance continuously. The continuous measurement and display of a central and a peripheral temperature gives an early indication of cold stress before there is any fall in the baby's core temperature.