Temperature control in the neonate

The control of body temperature is a challenge to the newborn baby, particularly if immature or sick. Behavioural responses to environmental temperature changes are almost non-existent. The preterm baby has limited ability to mobilize energy sources to combat high heat losses, particularly from evaporation. There is evidence that many preterm babies are still being allowed to get cold during stabilization and resuscitation. A low temperature at the time of admission to a neonatal unit is independently associated with an increased mortality in the preterm infant. Preventing evaporative heat losses at this time can abolish hypothermia on admission. Further studies are needed to determine the optimum thermal management immediately after delivery. There are no studies that show any difference in outcome for preterm babies nursed in incubators compared to those under radiant heaters. High transepidermal water loss (TEWL) results in increased fluid and heat loss in the preterm baby. This can be managed by increasing environmental humidity although this may be more difficult when babies are nursed under radiant heaters. Nursing the baby in high humidity reduces TEWL but more work is needed to show if a reduction in water movement has an adverse effect on the rate of maturation of the skin. The way a baby interacts with their environment is always changing and, whatever temperature and humidity settings are first used, it is necessary to monitor continuously the thermal balance. 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.