Thermoregulation and Heat Loss Prevention After Birth and During Neonatal Intensive‐Care Unit Stabilization of Extremely Low‐Birthweight Infants

Knobel, Robin B.; Holditch‐Davis, Diane

doi:10.1111/j.1552-6909.2007.00149.x

Cited by 92 publications

(65 citation statements)

References 24 publications

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“…14 The latter process is ineffective in preterm infants, because it depends on the amount of brown fat as well as levels of the enzymes 5 0 /3 0 -monodeiodinase and thermogenin, which build up only later in fetal development. 13 Shivering is not regularly involved in a newborn's reaction to cold stress. 16 Another mechanism of heat production is infant behavior: 10 the irritable baby prompts the mother to hold the baby, drying, cuddling and swaddling him or her, thus preventing heat loss.…”

Section: Neonatal Thermoregulationmentioning

confidence: 99%

“…12 When the infant's body temperature decreases in response to sudden exposure to cold extrauterine environments, signals from peripheral and central thermoreceptors reach the hypothalamus through afferent pathways. 13 The resulting norepinephrine release then triggers nonshivering thermogenesis, or lipolysis of brown adipose tissue, which is the main homeothermic heat production mechanism in newborns. Heat production occurs through uncoupling ATP synthesis via the oxidation of fatty acids in the mitochondria, utilizing uncoupled protein.…”

Section: Neonatal Thermoregulationmentioning

confidence: 99%

“…10 Pathophysiology of newborn hypothermia The World Health Organization (WHO) defines neonatal hypothermia as a temperature below 36.5 1C (97.7 1F) and proposes the following classification: 17 Mild hypothermia, caused by cold stress, is classified as a body temperature range from 36 to 36.5 1C (96.8 to 97.7 1F) and is considered a cause for concern, 17 because the exposed infant begins to lose more heat than he or she can produce. 13 Moderate hypothermia is a body temperature from 32 to 36 1C (89.6 to 96.8 1F), indicating danger and requiring warming of the baby. According to the WHO classification, a body temperature of <32 1C (89.6 1F) is considered severe hypothermia, or cold injury, with a potentially grave outcome, and needs immediate skilled attention.…”

Section: Neonatal Thermoregulationmentioning

confidence: 99%

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Thermal protection of the newborn in resource-limited environments

2012

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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.

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Section: Neonatal Thermoregulationmentioning

confidence: 99%

Section: Neonatal Thermoregulationmentioning

confidence: 99%

Section: Neonatal Thermoregulationmentioning

confidence: 99%

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Thermal protection of the newborn in resource-limited environments

2012

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“…These guidelines are reviewed in detail by Knobel and Holditch-Davis. 2 Delivery room temperatures of at least 25 1C (77 1F) are recommended. In most of these protocols involving healthy term infants, the approach of drying, placing the infant on warm linens, placing a cap on the infant's head and, if stable, being given to the mother so there can be direct skin-to-skin contact is recommended.…”

Section: Hypothermiamentioning

confidence: 99%

Heat loss prevention in neonates

Soll

2008

J Perinatol

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Maintaining a neutral thermal environment is one of the key physiologic challenges a newborn infant faces after delivery. Attention to detail regarding the management of an infant's neutral thermal environment may lead to improvement in clinical outcome, including improved survival. The details of this management cover a broad spectrum of interventions, from attention to the general environment (such as delivery room temperature) to specific individualized therapies, such as the use of polyethylene occlusive skin wrap. Although an integral part of the routine care of all newborns (whether term or preterm), these interventions have unfortunately received little attention and study. A commitment to greater understanding of these issues and their impact on newborns is essential if we hope to improve their outcome.

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“…Maintaining a normal body temperature is a critical function for newborn survival. 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].…”

Section: The Global Burden Of Neonatal Deaths and Its Relation To Hypmentioning

confidence: 99%