Therapy & Practice
Addressing critical clinical topics in neonatal care

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Thermoreguation - careful heat management

Thermoregulation is a critical physiologic function that is closely associated with the neonate’s survival.1 Extremely low-birthweight infants have inefficient thermoregulation due to immaturity—and caregiver procedures such as umbilical line insertions, intubations, and chest x-rays can lead to heat loss as well.2 As a result, infants may exhibit cold body temperatures after birth and during their first 12 hours of life. Thermoregulation plays a unique—and crucial—role in the nurturing and development of neonates. It helps neonatal care practitioners to provide a balanced environment through the management of temperature, thermomonitoring and humidity.

From signaling stress to identifying potentially serious complications, thermoregulation helps create the stable, individualized microclimate that babies need to thrive. 

Two main mechanisms control heat production:

  • Chemical thermogenesis
  • Muscle activity

Four mechanisms create heat loss:  

  • Radiation
  • Convection
  • Conduction
  • Evaporation

Explore the resources below to learn more about thermoregulation. For more research, articles and information go to the download center.

The basics of thermoregulation

Simple and informative clip describing the importance of thermoregulation for newborns and it's impact on their development. This clips explains the types of heat loss to look out for and the ideal thermoneutral environment for the baby.

Why humidity?

Maintaining fluid and heat balance is of vital importance to the newborn infant. At birth, the infant is exposed to a cold and dry environment, putting preterm neonates, in particular, at risk of dehydration and hypothermia. 

Preterm neonates have a high rate of water and heat loss mainly because of their immature skin. The care environment influences the magnitude of water and heat exchange, and needs to be individually tailored on the basis of the infant’s:

  • Clinical status
  • Maturity at birth
  • Postnatal age

Impact on VLBW infants

Thermoregulation is essential for premature babies to survive and extremely premature babies are particularly vulnerable. Dr. Manuel Sánchez Luna, MD, PhD, from the University Hospital in Madrid, explains how drops in body temperature impact the VLBW infants and even further how cold stress can affect mortality.

The hidden parameter?

Warming therapy for preterm infants is not a new topic, however, it may not always be getting the focus it deserves in research and practice. Dr. Egbert Herting,  University Clinic in Schleswig-Holstein, Germany, explains the relevance of thermoregulation and why it is so critical.

Optimising the thermal environment

Dr. Andrew Lyon, constultant neonatologist from Edinburgh says, “I believe we need to be very obsessional about basic care and temperature control is one of the major aspects in the basic care of a preterm baby". Watch to learn more.


Thermomonitoring is critical in determining the correct choice in environmental temperature. By continuously measuring both central and a peripheral body temperature, caregivers can identify changes in the difference between these two temperatures, giving an early indication of thermal stress long before any change in the central temperature is seen.

Central-peripheral temperature monitoring, along with monitoring of air temperature and humidity in the incubator, allows caregivers to achieve temperature stability.

Thermomonitoring explained by Dr. Lyon

Dr. Andrew Lyon explains the importance of thermomonitoring. He starts by reviewing sites where temperature can be measured and goes on to give further insights on how to use these measured thermal changes as means to gain more information as to what is happening to the baby.

1 Hackman PS. Recognizing and understanding the cold-stressed term infant. Neonatal Network. 2001;20(8):35-41.

2 Knobel R, Holditch-Davis D. Thermoregulation and heat loss prevention after birth and during neonatal Intensive-care unit stabilization of extremely low-birthweight infants. JOGNN. 2007;36(3):280-287.

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