A recent narrative review on thermoregulation strategies for very preterm infants in the delivery room highlights significant advancements in neonatal care. Preterm infants, particularly those born before 32 weeks of gestation, are highly vulnerable to temperatures outside the normal range. Exposure to temperatures above or below normothermia is strongly associated with increased mortality and morbidity. This research stresses the importance of preventing hypothermia while mitigating the risks of hyperthermia, both of which can have serious consequences for neonatal health.    Defining key terms in neonatal thermoregulation  The distinction between thermoregulation and temperature management is important: thermoregulation refers to the body’s natural ability to maintain temperature, while temperature management involves external interventions to support these processes, particularly in preterm infants. Normothermia, defined as 36.5°C to 37.5°C, is the normal body temperature range and is critical for minimising health risks. Hypothermia, below 36.5°C, increases the risk of infection and mortality, while hyperthermia, above 37.5°C, often caused by excessive warming, can result in dehydration, metabolic stress, and neuronal injury.   Modern strategies for thermoregulation in neonatal care  The focus on thermoregulation evolved from basic incubators to contemporary practices such as radiant heat, polyethylene wraps, and exothermic mattresses. The World Health Organization (WHO) and the International Liaison Committee on Resuscitation (ILCOR) currently recommend maintaining a temperature range of 36.5°C to 37.5°C, achieved through a combination of heated, humidified gases, optimised room environments, and external heat sources. However, using these measures during delayed cord clamping, a practice that is becoming more common for its benefits for newborns, remains a difficult task.   Breakthrough insights in newborn thermal management    The review highlights that polyethylene wraps and hats are effective in reducing heat loss through evaporation and conduction, making them important tools in neonatal thermoregulation. Radiant heat systems, exothermic mattresses, and heated, humidified gases are effective but need careful management to avoid the risk of hyperthermia. Emerging practices such as immediate skin-to-skin contact in the delivery room show potential benefits, particularly for fostering parental bonding, but may not fully ensure thermal stability for preterm infants. Therefore, mobile resuscitation trolleys equipped with thermal regulation features are increasingly important. Challenges in thermoregulation include inconsistent definitions of hypothermia and hyperthermia, complicating interventions, and difficulties in maintaining normothermia during delayed cord clamping, particularly in resource-limited settings. A comprehensive approach, combining advanced technologies, staff training, and global standards, is essential, with further research needed to optimise thermal strategies.   Paper available at: https://pubmed.ncbi.nlm.nih.gov/38253875/   Full list of authors: Dunne EA, O’Donnell CPF, Nakstad B, McCarthy LK  DOI: 10.1038/s41390-023-02902-w

Thanks to the dedicated work of Architect Corina Croitoru, founding member of the Romanian Association for Long-term Hospitalized Newborns (ARNIS), and Professor Maria Livia Ognean, the three standards on NICU design have been translated into Romanian. This milestone was celebrated with a presentation at the Romanian Neonatology Conference, introducing the standards to a national audience and highlighting their potential to enhance neonatal care. The Romanian translation represents a key step toward adopting these internationally recognised standards in Romania, aiming to provide the best environment for preterm infants. The standards’ release is especially timely, as Romania prepares for a period of hospital redesign and construction, creating a unique opportunity to integrate these guidelines into future NICU projects. This initiative aims to inspire hospitals, architects, and healthcare teams to collaborate in designing NICUs that transcend superficial improvements, creating spaces fully optimised to support the best possible care for preterm infants, their families, and the dedicated professionals who care for them. To access the Romanian standards, please visit this page.

A new study has found that immediate skin-to-skin contact (SSC) between parents and their very preterm infants after birth can significantly enhance the quality of mother-infant interactions at 4 months of age. This groundbreaking research, conducted across neonatal units in Sweden and Norway, offers compelling evidence for the long-term benefits of early physical bonding in premature babies.   Incubator care vs. early skin-to-skin contact in preterm infants The study analysed data from 71 very preterm infants born between 28 and 33 weeks of gestation. Researchers randomly assigned the infants to either standard incubator care or immediate skin-to-skin contact (SSC) with a parent for the first six hours after birth. At 4 months of corrected age, the mother-infant pairs were videotaped during a free-play session. These interactions were then assessed using the Parent-Child Early Relational Assessment (PCERA), a tool designed to measure the quality of parent-infant relationships.   Significant benefits of early skin-to-skin contact on infant development The results were striking. Infants who received immediate SSC after birth showed significantly higher scores in positive affect, communicative skills, and social skills compared to those who received standard care. This improvement was observed even though fathers provided more SSC than mothers in the initial hours after birth. However, the study’s key findings indicate that immediate skin-to-skin contact (SSC) should be encouraged alongside necessary medical care to strengthen the mother-infant relationship after birth. This practice is crucial for enhancing interactions between mothers and their very preterm infants, leading to improved developmental outcomes.   © Pixabay   Implications for neonatal care These results have significant implications for neonatal care practices. They provide strong support for the World Health Organization’s recent guidelines recommending immediate SSC for preterm infants. As survival rates for very preterm infants continue to improve, focusing on developmental outcomes becomes increasingly important. By implement policies that facilitate immediate SSC they may be able to improve long-term developmental outcomes and strengthen the crucial bond between parents and their premature babies.   Paper available at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812391 Full list of authors: Siri Lilliesköld, RN, MSc; Karoline Lode-Kolz, MD; Siren Rettedal, MD, PhD; Johanna Lindstedt, MSc; Agnes Linnér, MD, PhD; Hanne Markhus Pike, MD; Sari Ahlqvist-Björkroth, PhD; Ulrika Ådén, MD, PhD; Wibke Jonas, RM, PhD DOI: 10.1001/jamanetworkopen.2023.44469