Thermoregulation

The importance of maintaining the body temperature of a newborn baby is not a new concept. However, it is difficult to know which temperature to measure – and while the regular measurement of a single temperature tells us how well a baby is able to maintain that temperature, it does not give us any information on energy being used for thermoregulation. Hypothermia in newborns, needs careful management and can affect patient outcomes. Although this issue is serious, thermoregulation in newborns is still an underrated factor in many hospitals.

What’s in a temperature?

What happens if a baby gets too cold?

We lose heat through four different mechanisms: convection, radiation, conduction and evaporation. When a newborn’s temperature is too low, it causes stress and can exacerbate lung problems, leading to an increased need for ventilation. Metabolic acidosis increases and growth is affected, which can increase the length of hospital stay. Bilirubin is displaced from albumin binding sites, raising the risk of kernicterus. All these issues can lead to increased rates of morbidity and mortality. Minimizing all four types of heat loss and preventing cold stress is therefore a necessity.

Baby holds onto caregiver’s finger while resting in the NICU

How does the body react to environmental temperatures?

The body attempts to maintain its temperature within narrow limits and, if exposed to thermal stresses, will utilize energy to achieve temperature stability. It is not possible in ‘day to day’ neonatal care to measure heat transfer or energy expenditure in the baby so you have to rely on information from temperature measurements. A better overall picture of the thermal stresses experienced by a baby emerges if more than one body temperature is measured simultaneously.

Dr. Manuel Sánchez Luna talks about how cold stress affects premature babies and why thermoregulation is important

The consequences of heat loss

Even for adults, hypothermia can have very serious consequences. For very low birth weight infants, the consequences are much more serious. Dr. Manuel Sánchez Luna, MD, PhD of the University Hospital, Madrid, explains that even brief interruptions in warming therapy can be problematic.

How can we help a premature baby regulate body temperature?

Warming therapy used for thermoregulation

Thermoregulation and ThermoMonitoring

In comparison with an adult, a premature baby does not have mechanisms like sweating and shivering, and its metabolism is also limited. The only response to cold stress is vasoconstriction, which is seen with ThermoMonitoring. Therefore, it should be the target of nursing care to keep the baby within its “thermo neutral” range in order to provide the best conditions for growth and maturity.

Prof. Dr. Egbert Herting talks about why a bigger focus should be put on thermoregulation in neonatal care

The relevance of neonatal thermoregulation

Warming therapy for premature babies is not a new topic – and yet comparatively speaking, little research has been done on this subject. Prof. Dr. Egbert Herting of the Clinic for Paediatric and Youth Medicine at the University Hospital in Schleswig-Holstein, Germany, talks about the need for more attention to be given to this aspect of care.

“We have already been practicing ThermoMonitoring for 11 years. The main advantage from our point of view is that we are able to see a critical situation for the baby much earlier.”

Barbara Schulz, Head Nurse – Heinrich Heine Universität, Zentrum für Kinderheilkunde Düsseldorf