pediatrics
Hypothermia in Neonates
Prevention of Hypothermia in Neonates
Maintaining an appropriate environmental temperature is the most important step in preventing hypothermia in neonates. The World Health Organization (WHO) recommends the delivery room temperature be at least 25 to 28° C (77.0 to 82.4° F) and that neonates be dried immediately and placed in skin-to-skin contact with the mother and covered. (See also the WHO'spractical guide to thermal protection of the newborn.) Preterm infants who are hypothermic when admitted to the neonatal intensive care unit (NICU) have increased morbidity and mortality; increasing the temperature in the delivery and operating rooms has been found to reduce the incidence of hypothermia on NICU admission. Thus, the American Academy of Pediatrics and the American Heart Association recommend that delivery and operating rooms where preterm infants are delivered have a temperature of 23 to 25° C (74 to 77° F) ( Prevention references ). Because raising room temperature only when delivery is anticipated may allow radiant heat loss to cool surfaces and convective heat loss caused by rapid airflow, the room should be maintained at the recommended temperature continually. At the time of birth, neonates should be immediately dried and then swaddled (including the head) in a warm blanket to prevent evaporative, conductive, and convective losses. For a preterm infant, placement into a polyethylene bag immediately after delivery has been found to help maintain the infant's temperature; some clinicians do not dry the infant before placement in the bag because the increased humidity may be beneficial ( Prevention references ). A neonate exposed for Neonatal Resuscitation or observation should be placed under a radiant warmer without anything blocking heat to the neonate, such as a blanket, to prevent radiant losses. Sick neonates should be maintained in a neutral thermal environment to minimize the metabolic rate. The proper incubator temperature varies depending on the neonate’s birthweight and postnatal age, and humidity in the incubator. Alternatively, heating can be adjusted with a servomechanism set to maintain skin temperature at 36.5 1.Weiner GM, ed:Textbook of Neonatal Resuscitation, ed. 8. Itasca, American Academy of Pediatrics, 2021. 2.Oatley HK, Blencowe H, Lawn JE: The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates.J Perinatol36(Suppl 1):S82–S88, 2016. doi: 10.1038/jp.2016.35 