Thermal protection of the newborn in resource-limited environments

Abstract

Appropriate thermal protection of the newborn prevents hypothermia and its associated burden of morbidity and mortality. Yet, current global birth practices tend to not adequately address this challenge. Here, we discuss the pathophysiology of hypothermia in the newborn, its prevention and therapeutic options with particular attention to resource-limited environments. Newborns are equipped with sophisticated mechanisms of body temperature regulation. Neonatal thermoregulation is a critical function for newborn survival, regulated in the hypothalamus and mediated by endocrine pathways. Hypothermia activates cellular metabolism through shivering and nonshivering thermogenesis. In newborns, optimal temperature ranges are narrow and thermoregulatory mechanisms easily overwhelmed, particularly in premature and low-birth weight infants. Hyperthermia most commonly is associated with dehydration and potentially sepsis. The lack of thermal protection promptly leads to hypothermia, which is associated with detrimental metabolic and other pathophysiological processes. Simple thermal protection strategies are feasible at community and institutional levels in resource-limited environments. Appropriate interventions include skin-to-skin care, breastfeeding and protective clothing or devices. Due to poor provider training and limited awareness of the problem, appropriate thermal care of the newborn is often neglected in many settings. Education and appropriate devices might foster improved hypothermia management through mothers, birth attendants and health care workers. Integration of relatively simple thermal protection interventions into existing mother and child health programs can effectively prevent newborn hypothermia even in resource-limited environments.

Hypothermia and Related Factors in High-Risk Infants

“…While all these causes of death are associated with neonatal hypothermia, the direction of causality is unclear [7]. Although usually infections (mostly sepsis and pneumonia) are listed as cause of death rather than hypothermia, it is unclear whether hypothermia is the underlying cause or the consequence of severe infections.…”

“…A newborn's thermal regulatory mechanisms are highly sophisticated, but particularly in babies born prematurely easily overwhelmed [7]. Neonatal anatomic characteristics add to the metabolic burden of increased energy requirements: term babies have a 2.7 times greater body surface and preterm babies an up to 4.0 times greater surface per weight than adults.…”

“…Newborns achieve this through sophisticated mechanisms of body temperature regulation controlled by the hypothalamus and mediated by endocrine pathways through shivering and non-shivering thermogenesis [6]. However, particularly in premature and low birth weight infants, thermoregulatory mechanisms are easily overwhelmed, leading to metabolic deterioration and direct death from hypothermia or indirect mortality from associated mortalities such as severe infections [7].…”

Polyethylene wrap for maintaining the body temperature of the newborn

“…Estratégias de proteção térmica simples são viáveis nos níveis comunitário e institucionais em ambientes de recursos limitados. Intervenções apropriadas incluem cuidados com a pele-a-pele, amamentação e vestuário de protecção ou dispositivos para manutenção da temperatura corporal (Lunze & Hamer, 2012). Um estudo realizado por Magalhães et al (2010) com 26 RNPT, constatou que a incidência de manuseamento para cuidados de rotinas durante o período de 24 horas variou de 52 a 79, sendo a maioria realizada pela equipa de Enfermagem.…”

Changes in physiological and behavioral parameters of preterm infants undergoing body hygiene: a systematic review

“…Particularly in moderate and extreme preterm infants, the term of the regulatory mechanisms are easily overlapped, leading to metabolic deterioration and death from hypothermia or other associated causes such as serious infections (7) .…”