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Neonatal hypothermia remains a significant global concern due to its high prevalence and potential to adversely impact infant outcomes. Ensuring that healthcare professionals are equipped with the knowledge, clinical confidence, and appropriate tools to manage and reduce the risk of hypothermia is essential. This article explores the nature of the condition, associated risks, and commonly recommended management strategies.

Defining neonatal hypothermia

Hypothermia can commonly affect babies shortly after birth, and it is defined as a core temperature below 36.5ºC.ⁱ  Heat loss can occur in several ways, putting infants at risk:ⁱⁱ 

• Radiant – bare skin exposed to a cooler environment
• Evaporative – as the amniotic fluid on babies dries
• Conductive – neonate is in contact with a cooler surface or object
• Convective – flow of cool ambient air

Prevalence of neonatal hypothermia 

The global prevalence of neonatal hypothermia is estimated to range between 32-85% for children born in hospitals and 11-92% for children born at home, with higher rates reported in developing countries. Determining the exact impact on mortality is difficult. However, it has been suggested that 36% of all neonatal deaths are linked to infection, 29% to prematurity, 23% due to asphyxia, and 19% to congenital malformations and other related causes. All these conditions are associated with neonatal hypothermia.ⁱⁱⁱ 

Addressing hypothermia in infants is important, as the condition can lead to complications such as hypoglycaemia, hypoxaemia, acidosis, and reduced cardiac output. Preterm infants are particularly vulnerable due to their relatively large surface area, immature physiological development, and limited thermoregulatory control.^iv 

Recognising signs and symptoms

Some of the symptoms of neonatal hypothermia can be difficult to spot, so it’s important to be confident in knowing what to look out for. Signs may include vasoconstriction presenting as pale, cold or mottled skin; lethargy; feed intolerance or vomiting; increased oxygen requirement or respiratory distress; apnoea; hypotonia; and hypoglycaemia.  

Risk assessment and management challenges

Comprehensive assessments should be completed to eliminate the risk of hypothermia in neonates and enable professionals to act quickly if heat loss is occurring. For healthcare professionals, everything from evaluation of the immediate environment to the avoidance of bathing in the first 24 hours of life, the heating and humidifying of required inspired gases, and the proper transport, must be considered and managed carefully.^v 

The delivery room, for example, should be at least 25ºC, though this may be difficult to consistently achieve in winter months or rural areas, especially with the regular opening and closing of doors. Immediate drying of the baby is also essential, so the appropriate cloths should be to hand at the time of birth. WHO recommendations also highlight the importance of appropriate clothing and blankets for the infant, as well as warm transportation devices, all reducing the risk of hypothermia.^vi  

Supporting Neonatal Thermoregulation

To support optimal thermal care for newborns during the first few hours and days after birth, the SafeWarm Mobile Neonatal Patient Warming System from HMG Medical, available from Getz Healthcare Australia & New Zealand , offers an effective solution. This warming portfolio includes mattresses and swaddling blankets specifically designed to help reduce the risk of neonatal hypothermia during transport.

This portfolio of warming blankets and mattresses includes the following key features:

• Designed to prevent newborn hypothermia during transport
• Uniformly warms swaddling blanket in just 10 minutes
• Lightweight swaddling blanket 
• Precise 0.1ºC increments for meticulous temperature control (32-39ºC) with LED display
• Enhanced safety includes audio-visual alarms and high-temperature cut-off

 

Request a DEMO today to find out more!

 

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ⁱ World Health Organization. WHO_RHT_MSM_97.2_Thermal protection of the Newborn.pdf. 1997.

ⁱⁱ MSD Manual. Hypothermia in neonates. Revised November 2023. [Accessed November 2023]

ⁱⁱⁱ Lunze K, Bloom DE, Jamison DT, Hamer DH. The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival. BMC Med. 2013 Jan 31;11:24. doi: 10.1186/1741-7015-11-24. PMID: 23369256; PMCID: PMC3606398.

^iv Singh, T.S., Skelton, H., Baird, J., Padernia, A.-M., Maheshwari, R., Shah, D.M., D'Cruz, D., Luig, M. and Jani, P. (2022), Improvement in thermoregulation outcomes following the implementation of a thermoregulation bundle for preterm infants. J Paediatr Child Health, 58: 1201-1208.

^v The Children’s Hospital. Thermoregulation in neonatal care – CHW. Practice Guideline. Guideline no. 2007-0006 v4. [Accessed November 2023]

^vi World Health Organization 1997. WHO_RHT_MSM_97.2_Thermal protection of the Newborn.pdf