Temperature Stability Technologies for Newborns (Incubators, Radiant Warmers, Wraps, Cooling devices)
Importance of Temperature Stability Technologies for Newborns
Neonatal hypothermia occurs when a newborn’s body temperature drops below 36.5°C (97.7°F). For every 1°C reduction in body temperature, there is a significant risk for neonatal mortality and morbidity. (1) Pre-term and low-birth-weight have less fat to generate heat, and are therefore at greater risk for hypothermia. (2)
Hypothermia is categorized into three levels by the World Health Organization: (2)
- mild: 36°C–36.5°C;
- moderate: 32°C–35.9°C; and
- severe: <32°C)
The ambient temperature during and after delivery has a significant effect on risks to the newborn of developing hypothermia. In the 10-20 minutes occurs in the 10-20 minutes immediately after birth when newborn may lose enough heat for the body temperature to fall by 2-4°C without appropriate interventions. (3)
Although practices such as drying, wrapping, initiating breastfeeding, and practicing skin-to-skin contact (or Kangaroo Mother Care (KMC)which is prolonged skin-to-skin contact) are all part of essential newborn care to improve health outcomes of preterm and sick newborns, it is not always possible or may be insufficient. In those cases, there is a need for additional support for temperature stability, or thermal regulation, of a newborn through warming technologies. (3)
Hyperthermia can occur if the infant is warmed to quickly; rapid changes in temperature can cause thermal shock which presents other critical health risks; hyperthermia may also be indicative of fever or a different underlying health condition. The usual approach to treating a hyperthermic newborn is to carefully monitor any warming intervention, and also adjust environmental conditions. The newborn should be moved away from the source of heat, and undressed partially or fully, if necessary. If the newborn is in an incubator, the air temperature should be lowered. It is important that the newborn be breastfed frequently to replace fluids (4).
Birth Asphyxia, the second leading cause of neonatal deaths worldwide, can cause Hypoxic Ischemic Encephalopathy (HIE). Intentionally inducing therapeutic hypothermia by cooling the newborn’s internal body temperature to 33.5⁰C and maintaining the temperature between 33⁰C and 34⁰C for 72 hours can reduce the risk of death or major disability and increases the rate of normal survival at the age of 18 months among new born with birth asphyxia. This intervention requires cooling technologies.
Types of Temperature Stability Technologies
- Radiant Warmer Beds
- Cooling technologies
Key Considerations for Selecting the Appropriate Temperature Regulation Technologies
- Setting. If the newborn is being cared for in a Neonatal Intensive Care Unit (NICU), a more basic healthcare facility, at home, or being transported to a higher-level referral facility should inform which type of technology is more appropriate. For example, incubators are the most cost intensive technology most likely for higher level facilities, whereas wraps and mattresses may be more suitable for lower levels of care or even community and household settings.
- Purpose of device. The purpose of the device may vary- to provide insultation (prevent hypothermia), to warm an infant to manage mild hypothermia or for transport, or more aggressive infant thermoregulation for sick infants to need more treatment and monitoring. These considerations, as well as the infrastructure and skills of the available health care providers are important for appropriate device selection. (7)
- Age, size, and health condition of the newborn. If there are multiple health issues and a newborn requires more interventions than thermoregulation, the most appropriate device may be one that enables better access for care providers
- Accessibility and Visibility. Depending on age, health, and size of the newborn, having a device that enables greater visibility and access to the newborn for other health interventions may be just as important as the warming technology itself.
- Temperature Control. Careful temperature monitoring is critical to ensure that the technology is performing appropriately without causing rapid temperature fluctuations that could lead to hyperthermia or thermal shock. Temperature monitoring should be within ±0.3°C and, at least the incubators and radiant warmers should have fail-safe modes.(5)
- Power supply. Technology, specifically incubators and radiant warmers should match the voltage and frequency of the purchasing country’s local power grid (e.g., 110-120 VAC at 60 Hz or 220-240 VAC at 50 Hz)
- Cleaning and Maintenance. Devices such as incubators and radiant warmers have servocontrols which relate the infant temperature (sensor on abdomen) to the temperature of the warming device. Incubators, because of water reservoirs used to manage humidity, require more intensive routine cleaning and maintenance to prevent microbial growth
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References and Acknowledgments
(1) Belches TC, Tilly AE, Miller TR, et al. Randomized Trial of Plastic Bags to Prevent Term Neonatal Hypothermia in a Resource-Poor Setting. Pediatrics. 2013; 132(3):e656-e661.
(2) WHO (1997) Thermal Protection of the Newborn: A Practical Guide. Maternal and Newborn Health/Safe Motherhood Unit, Division of Reproductive Health, World Health Organization, Geneva.
(3) PATH, Thermoregulation Devices: Guide to Selection, November 2014.
(4) Newborn Thermoregulation Module. Champlain Maternal Newborn Regional Program (CMNRP). June 2013.
(5) NEST360° and UNICEF. Target Product Profile; Radiant Warmer. 1st Edition, March 2020.
(6) Bell EF. Infant incubators and radiant warmers. Early Hum Dev. 1983;8(3-4):351-375. doi:10.1016/0378-3782(83)90018-x