TEMPERATURE CONTROL

IN THE NEONATE

Dr. Johanus Edwin,SpA

Introduction
Hypothermia associated with increased
morbidity/mortality in newborns of all birth
weights/ages
Now considered independent risk factor for mortality
in preterm
Western
philosophy of conventional care
premature baby should be
Placed under radiant warmer
Uncovered for full visualization and to allow radiant
heat to reach body
More
attention now focused on thermal care
immediately after birth and during resuscitation
Premature Susceptibility to
Heat Loss
High surface area to volume ratio
Thin non-keratinized skin
Lack of insulating subQ fat
Lack of thermogenic brown adipose
tissue (BAT)
Inability to shiver
Poor vasomotor response
Thermoregulation
Metabolic rate of fetus per tissue wt. higher than
adult
Heat also transferred from mother to fetus via
placenta/uterus
Fetal
temp consistently 0.3-0.5 deg C higher than
mothers (always in parallel)
Even when mothers temp elevates (eg fever)
Despite BAT in utero, fetus cannot produce extra
heat
Exposed to adenosine and prostaglandin E2 inhibitors
of non-shivering thermogenesis (NST)
Metabolic adaptation for physiologically hypoxic fetus
since NST requires oxygenation
Inhibition of NST allows accumulation of BAT
Thermoregulation
Heat gain/loss controlled by

hypothalamus and limbic system

Thermoregulatory system immature in

newborns
(esp premature newborn)
Thermoregulation
In term infant, response to cold stress
relies on oxidation of brown fat (NST)
Development begins 20th wk until shortly
after birth (comprises 1% body wt at that time)
High concentration stored TGs
Rich capillary network densely innervated by
sympathetic nerve endings
Temperature sensors on posterior
hypothalamus stimulate pituitary to produce
thyroxine (T4) and adrenals to produce
norepinephrine
Lipolysis stimulated energy produced in
form of heat in mitochondria instead of
phosphate bonds by uncoupling protein-1 (aka
thermogenin)
Thermoneutral
Environment
Temp and environmental conditions at
which metabolic rate and O2
consumption are lowest
Silverman et al
Maintaining constant abdominal skin temp b/w
36.2-36.5 deg C optimal
WHO classification of hypothermia
Mild: 36-36.4deg C
Mod: 32-35.9deg C
Severe: <32deg C
Risk Factors
All neonates in 1st 8-12hrs of life
Prematurity
SGA
CNS problems
Prolonged resuscitation efforts
Sepsis
Neonatal Energy Triangle
Adverse Consequences of
Hypothermia
High O2 consumption hypoxia, bradycardia
High glucose usage hypoglycemia /
decreased glycogen stores
High energy expenditure reduced growth
rate, lethargy, hypotonia, poor suck/cry
Low surfactant production RDS
Vasoconstriction poor perfusion
metabolic acidosis
Delayed transition from fetal to newborn
circulation
Thermal shock DIC death
Modes of Heat Loss
Conduction - direct heat transfer from skin to
object (eg mattress)
Convection - heat loss through air flow
Also depends on air temp
Radiation - direct transfer by electromagnetic
radiation in infrared spectrum
Heat gained by radiation from external radiant energy
source
Heat lost by radiation to cooler walls of incubator
Evaporation - heat loss when water evaporates
from skin and respiratory tract
Depends on maximum relative humidity of
surroundings less humidity = more evaporation
Heat Loss at Birth
Hammarlund et al, 1980
Evaporative water loss
81-125 gm/m2/h when unwiped in ambient temp
~25.8deg C and 42% humidity
Heat loss through
Evaporation: 60-80 W/m2
Radiation: 50 W/m2
Convection: 25 W/m2
Conduction: negligible
Total heat loss = 135-155 W/m 2
All
babies that were >3250g - body temp
decreased 0.9deg C in 15min
Heat Loss at Birth
Hammarlund et al, 1979

Naked infants <28wks need ambient temp

~40C to maintain normal temp in 20%
humidity

Increasing humidity to 60% halved losses

 Management
Healthy newborn
Dried & wrapped in prewarmed clothes
Use of cap
Examination should be done under radiant
warmer
If temp is stable the infant should be placed
with blanket
Management

Sick newborn
Dried
Transportation
Radiant warmer
Use of cling wrap
 Management
Sick newborn
Incubator with maintenance of thermoneutral
zone temp.

Humidification of incubator
 Management
Newer devices
Double walled incubators
Limit radiant heat loss
Decrease convective and evaporative losses

Hybrid
devices

Giraffe Versalet
Kangaroo Mother Care
(KMC)
Introduced in 1983 by Rey and Martinez
in Colombia
LBW infants nursed naked (wearing only cloth
diaper) between mothers breasts
Data from other countries show infants nursed
by KMC have
Fewer apneic episodes
Similar or better blood oxygenation
Lower infection rates
Are alert longer and cry less
Are breastfed longer and have better bonding
Improved survival in low-resource settings
 Hazards of temp control
methods
1. Hyperthermia

2. Undetected infections

3. Volume depletion/ dehydration

Thank you