Hospital Sg.

Buloh Group
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 DEFINITION
Thermoregulation is the ability to balance heat loss and
heat production through normal thermoregulatory
mechanisms in order to maintain body temperature
within a normothermic range.
(Pate, 2001)

Neutral Thermal Environment (NTE) has been defined

as when the infants temperature does not change, with
a stable metabolic state and where minimal rates of
oxygen consumption or energy expenditure occured
(Knobel et al., 2007; Brown & Landers, 2011).

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NEUTRAL THERMAL
ENVIRONMENT (NTE)
NTE is best achieved
when infants can
maintain core
temperature between
36.5°C to 37.5°C.

(WHO, 1997; Brown & Launders, 2011;

Altimier, 2012)

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COMPLICATION ASSOCIATED WITH THERMO-INSTABILITY

Increase risk for the Infant who have decrease brown fat & decrease glycogen storage, high
TEWL, & lack muscle tone (WHO, 1997)
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 MECHANISMS OF HEAT TRANSFER

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 What is Conduction?
• It is transfer of heat between two solid objects of
different temperatures.

• Conductive heat loss can happen when baby placed

on cold operating table or radiography table etc.

• Conversely if baby placed close to heating pad, warm

blanket or mattress infant will gain heat at rate
directly proportional to temperature difference
between heat source and infant skin.
(Brand & Boyd, 2015)

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 CONDUCTION CONT….
Conduction can be prevented
• Placing a warm diaper or
blanket between the neonate
and cold surfaces –
• Placing infant on pre-warmed
bed at time of delivery
• Warming all objects that
come in contact with the
neonate
• Admitting infant to a pre-
warmed bed with warm
environment
• Skin to skin contact (KMC)
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 WHAT IS CONVECTION?
• Convection heat transfer due to air currents of draft.

• Convective losses happen when the ambient air

temperature is less than baby’s skin temp.
• Incubator transfer heat to infants through the
circulation of warm air.

• Heat loss will occur when infant exposed to cool air,

such as air conditioning or is placed into an incubator
that has not prewarmed
(Brand & Boyd, 2015)

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 CONVECTION HEAT LOSS
Cold Air
• Increase temperature in delivery
room
• Move away from air conditioning
vents
• Use radiant warmer

CONVECTION HEAT GAIN

Incubator
Monitor temperature frequently
until neutral thermal conditions are
established
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 WHAT IS RADIATION?
• Is transfer of heat from a warm object to a cooler
object that not in direct contact through infrared
energy transfer. (Brand & Boyd, 2015)

• When infants are placed near to windows or walls

heat is lost by radiation, even neonates placed in
incubators losses heat to incubator walls

• If the wall incubator are cold, infant may lose heat

and be cold-stressed despite warm air circulating
through the incubator (Blackburn, 2013)
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 RADIATION LOSS HEAT
Cold Incubator wall
Prewarmed incubator, use double-wall incubator

Cold Window
• Move away from window or window cover
• Use radiant warmer with servo control
(Brand & Boyd, 2015)

RADIATION GAIN HEAT

Direct Sunlight
Position away from window or close blind
Radiant warmer
Always use servo control
Heat lamp
Used it as a last choice and monitor baby
temperature frequently
(Brand & Boyd, 2015)

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 WHAT IS EVAPORATIVE?
• Is the heat transfer due to water vaporizing from the skin
or respiratory tract into the drier surrounding air and, in
case of premature infants with thin permeable skin,
through TEWL. (Brand & Boyd, 2015)
• For every ml of water that evaporates from baby, 580
calories of heat are lost. It depends on relative humidity of
environment and gestational age of infant.
• An infants evaporative loss accounts for 25% of heat
production, of this
– Respiratory tract-25%
– Trans epidermal water loss -75%

• It is not very significant in term infants, but it is very

significant in pre term and open surgical anomalies
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 EVAPORATIVE HEAT LOSS
Amniotic Fluid
• Place skin to skin with mother if condition allows
• Dry and wrap with warm blanket
• VLBW- place in polyethylene bag
Bathing
Warm room and water. Bathe quickly

EVAPORATIVE GAIN
Humidified Incubator
• Maintain prescribed humidity
Vasoconstriction
• Maintain NTE
• Avoid situation that contribute
to cold stress
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 REFERENCES
1. Pate, M. (2001). Thermoregulation. In Curley, M., & Moloney-Harmon, P. (Eds.), Critical
Care Nursing of Infants and Children (pp. 443 – 459). Philadelphia: W.B. Saunders Co.
2. World Health Organisation (1997). Thermal Protection of the Newborn: A Practical Guide.
Retrieved from:
http://passthrough.fwnotify.net/download/016828/http://apps.who.int/iris/bitstream/1
0665/63986/1/WHO_RHT_MSM_97.2.pdf
3. Brown, V.D. and Landers, S. (2011) Heat balance. In Gardner, S.L. Carter, B.S. Enzman-
Hines, M. and Hernandez, J.A. Merenstein and Gardner’s Handbook of Neonatal
Intensive Care, 7th Edition. Mosby Elsevier: St Louis,113-133.
4. Knobel, R. and Holditch-Davis, D. (2007) Thermoregulation and Heat Loss Prevention
after Birth and during neonatal Intensive Care Unit Stabilization of Extremely Low Birth
Weight Infants. Journal of Gynecological and Neonatal Nursing (JOGNN) 10(5S), 7-14.
5. Altimier, L. (2012) Thermoregulation: What’s new? What’s not? Newborn and Infant
Nursing Reviews, 12(1): 51-63.
6. Brand, M. C., and Boyd, H. A. (2015). Thermoregulation. In Verklan, M. T., Walden, M.,
AWHONN, American Asssociation of Critical-Care Nurses, & National Associatio of
Neonatal Nurse. Core Curriculum for Neonatal Intensive Care Nursing, 5 th Eds. (pp 95-
107). Elsevier Saunders: USA

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