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)
Hyperthermia, defined as body temperature > 37.5°C is as dangerous to newborns as hypothermia, but can be prevented by dressing the newborn appropriately (not too much), and temperature monitoring. Attempts to warm a cold baby too quickly or aggressively can result in hyperthermia. Rapid swings in temperature – known as thermal shock – can lead to negative outcomes, including death.
The World Health Organization (WHO) proposes a “warm chain”, a series of interventions to prevent or mitigate the risk of hypothermia in newborns: warming the delivery place; immediate drying; skin-to-skin care; early and exclusive breast-feeding to promote close warming contact with the mother; delaying bathing; appropriate clothing and bedding; and co-placement of mother with baby. (2) These practices, as well as prompt recognition of hypothermia and action to rewarm hypothermic infants can avert up to 40% of neonatal deaths. (7) However, for sick babies, or preterm babies, more monitoring and intervention may be required such as radiant warmers, incubators, heated mattresses, and special wraps and blankets.
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VIA Buyers Guides: Solutions for Temperature Stability in Newborns
All newborns should immediately be dried and warmed, initiate breastfeeding, and receive skin-to-skin contact. For preterm and sick babies, they may require additional Kangaroo Mother Care (KMC) (prolonged skin-to-skin contact), it may not always be possible and those babies may require other solutions to manage hypothermia and hyperthermia, or be referred to a higher-level facility. (5) Thermoregulation devices can be an important complement to KMC and improve newborn outcomes, especially for preterm and sick babies.
- Incubators continuously monitor and adjust temperature, and provide the most advanced warming technology. However, they a are typically more expensive due to their sensor systems and consumables, and require more extensive cleaning and maintenance to prevent infections and microbial growth
- Radiant Warmers can control heat based on manual settings and also provide easy access to the infant both who may require additional other interventions or procedures, and for feeding and changing. However, without close monitoring of temperature, warming beds can potentially increase dehydration (3)
- Heated Mattresses and Wraps also offer warming and heat stabilization, and can provide thermal care for preterm newborns immediately after birth, or be useful in the stabilization and transfer of infants to specialized neonatal facilities
- Temperature monitoring, combined with monitoring respiratory rate and using a pulse oximeter, is important for providers to determine what type of treatment to pursue; and assess if the baby is responding appropriately.
Selecting the appropriate solution for thermal management of a newborn depends on several factors. First, is the setting in which newborn care is a facility, house or community, or in transport on the way to a referral facility? Other considerations would be to define the purpose of the device, to provide insultation and prevent hypothermia, or warm an infant to manage mild hypothermia, 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)
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References and Acknowledgments
(1) World Health Organization Who | thermal protection of the newborn: a practical guide, 1997. Available: here
(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) NEST360° 2nd Edition Technical Report, February 2020.
(4) Sosa Saenz, Sonia E et al. “Evaluation of a continuous neonatal temperature monitor for low-resource settings: a device feasibility pilot study.” BMJ paediatrics open vol. 4,1 e000655. 7 May. 2020, doi:10.1136/bmjpo-2020-000655
(5) WHO Recommendation on Interventions to Improve Preterm Birth Outcomes. 2015. Found Here
(6) PATH. Thermoregulation Devices: Guide to Selection. 2014. Found Here
(7) Darmstadt GL, Walker N, Lawn JE, Bhutta ZA, Haws RA, Cousens S. Saving newborn lives in Asia and Africa: cost and impact of phased scale-up of interventions within the continuum of care. Health Policy and Planning. 2008;23:101–117.