The neonate has a relatively large surface-to-weight ratio, reduced metabolism per unit area, and small amounts of insulating fat, making him susceptible to hypothermia.

The neonate keeps warm by metabolizing brown fat, which is unique to neonates and has a greater concentration of energy-producing mitochondria in its cells, enhancing its capacity for heat production. Brown fat metabolism is effective, but only within a very narrow temperature range.

Without careful external thermoregulation, the neonate may become chilled, which can result in hypoxia, acidosis, hypoglycemia, pulmonary vasoconstriction, and death.

Thermoregulation provides a neutral thermal environment that helps the neonate maintain a normal core temperature with minimal oxygen consumption and caloric expenditure.

Core temperature varies with the neonate, but is about 97.7º F (36.5º C). Cold stress and its complications can be prevented with proper interventions.

Radiant warmer or incubator (if necessary) (see Understanding thermoregulators)

Blankets

Washcloths or towels

Skin probe

Adhesive pad

Water-soluble lubricant

Thermometer

Clothing, including cap

While preparing for the neonate’s birth, turn on the radiant warmer in the birthing room and set it to the desired temperature. Warm the blankets, washcloths, or towels under a heat source.

In the birthing room, place the neonate under the radiant warmer, dry him with warm washcloths or towels, then cover his head with a cap to prevent heat loss.

Perform required procedures quickly and wrap the neonate in the warmed blankets. If his condition permits, give him to his parents to promote bonding.

Transport the neonate to the nursery in the warmed blankets; use a transport incubator.

In the nursery, remove the blankets and cap and place the neonate under the radiant warmer.

Use the adhesive pad to attach the temperature control probe to the neonate’s skin in the upper-right abdominal quadrant. If the neonate will lie prone, put the skin probe on his back.