Thermoregulation In The NICU: Maintaining The Baby’s Temperature - NICU baby sleeping — Thermoregulation In The NICU: Maintaining The Baby’s Temperature
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Summary

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, whilst 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 the energy being used for thermoregulation. Conditions in babies such as Hypothermia need careful heat management and can affect patient outcome. Although this is a serious issue, thermoregulation is still an underrated factor in many hospitals.

What’s in a temperature?

Caregiver’s hand rests on baby’s head in the NICU

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. Minimising 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 utilise energy to achieve temperature stability. In day-to-day neonatal care, it’s not possible to measure heat transfer or energy expenditure in babies, so information from temperature measurements is relied on. A better overall picture of the thermal stresses experienced by a baby emerges if more than one body temperature is measured simultaneously.

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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 is not provided with mechanisms like sweating and shivering and its metabolism is limited as well. 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 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