Early detection of cold stress to prevent hypothermia: A narrative review

Abstract

Temperature monitoring is essential for assessing neonates and providing appropriate neonatal thermal care. Thermoneutrality is defined as the environmental temperature range within which the oxygen and metabolic consumptions are minimum to maintain normal body temperature. When neonates are in an environment below thermoneutral temperature, they respond by vasoconstriction to minimise heat losses, followed by a rise in metabolic rate to increase heat production. This condition, physiologically termed cold stress, usually occurs before hypothermia. In addition to standard axillary or rectal temperature monitoring by a thermometer, cold stress can be detected by monitoring peripheral hand or foot temperature, even by hand-touch. However, this simple method remains undervalued and generally recommended only as a second and lesser choice in clinical practice. This review presents the concepts of thermoneutrality and cold stress and highlights the importance of early detection of cold stress before hypothermia occurs. The authors suggest systematic clinical determination of hand and foot temperatures by hand-touch for early detection of physiological cold stress, in addition to monitoring core temperature for detection of established hypothermia, particularly in low-resource settings.

From Warm to Cold: Feeding Cold Milk in Preterm Infants with Uncoordinated Oral Feeding Patterns

“…Our study showed that when cold milk is fed orally to preterm infants, it reaches the stomach at an approximate temperature of 83.3 °F, which is above the typical room temperature range (68-77 °F) that is used when milk is introduced directly into the stomach via NGT or OGT feeding methods. [37] Since it was not the focus of our study, we did not investigate the effects of introducing cold milk directly to the stomach via NGT. Our findings are consistent with a study conducted on adult volunteers, which observed that gastric temperatures returned to within 1 degree of core body temperature within 30 minutes of consuming a cold drink.…”

“…[31][32][33][34] These studies revealed tolerance to cold feeding with no significant adverse effects on the infants' sleep patterns, vocalizations, motility, intake, feeding behavior, weight gain, temperature, frequency of regurgitation, or gastric emptying time. While previous studies demonstrated the safe use of cold feedings, [31][32][33][34] there are concerns that cold feeding will induce digestive malfunction [35,36] or cold stress associated with an axillary or rectal temperature of 36.0°C-36.4°C [37] and physiological manifestations. Furthermore, preterm infants are at an increased risk of necrotizing enterocolitis and hypothermia, which have been linked to increased risk of adverse neonatal outcomes.…”