2024-12-09 / News
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