Thermal stability is crucial to the well-being of preterm infants. Preterm infants can experience hypothermia directly after birth, and during the course of their hospitalization. In a term infant, subcutaneous fat acts as an insulator to prevent excess heat loss, but preterm infants have decreased fat stores, and lose heat through their skin and respiratory tract.
A large body of evidence that spans decades demonstrates associations between hypothermia and increased neonatal morbidity and mortality. As neonatal therapists, we are not only responsible for making certain that the infants with whom we interact maintain thermal stability during our treatments, but also for collaborating with other NICU professionals to ensure that the NICU environment itself promotes optimal growth and development.
A researcher from Duke University conducted a review of literature examining interventions promoting thermoregulation in preterm infants. Based on current literature, recommendations for practice were suggested:
- Monitor the room temperature and humidity levels in the unit, as preterm infants can lose heat quickly when the incubator has to be open for longer procedures. Extra care should be taken to check room temperature and humidity during changes of season.
- Current evidence supports that rooms should be kept at 22-26 degrees Celsius, with relative humidity of 30-60%.
- Double wall incubators should be used when possible, and providers should minimize the amount of time that babies are outside of the incubator.
- Kangaroo care promotes thermal stability and should be encouraged.
- Consider transitioning preterm infants from incubator to open crib at 1,500-1,600 grams versus 1,800 to promote thermoregulation and growth.
The article also includes guidelines for temperature and humidity levels inside of the incubator, as well as recommendations for reducing heat loss directly after birth. Please see the link to the full text article below.
Hypothermia remains common in preterm infants, and neonatal therapists have a role in promoting thermoregulation as it relates to safety, comfort, growth, and development. Despite well researched practice guidelines, more research is still needed to discover best practices for encouraging thermoregulation.
Knobel-Dail, RB. (2014). Role of effective thermoregulation in preterm neonates. Research and Reports in Neonatology, 4, 147-156.
