Neonatal hypothermia management by infant warmers

Hypothermia is defined by the World Health Organization as a core temperature < 36.5° C (97.7° F). In preterm infants, hypothermia increases morbidity and mortality. Hypothermia may be purely environmental or represent intercurrent illness (eg, sepsis). Maintaining an appropriate environmental temperature in the delivery room or operating room is critical in preventing neonatal hypothermia. Hypothermic infants should be rewarmed, and any underlying condition must be diagnosed and treated.

The problem of hypothermia in newborns is a vital issue. It is a global problem in neonates born both at hospitals and homes, but it showed a higher prevalence in developing countries (>90%). Although hypothermia is rarely a direct cause of death, it contributes to a substantial proportion of neonatal mortality globally.

As a result of their small size compared to large surface area, babies can get cold very quickly. Infants rapidly lose body heat, as they cannot produce enough body heat by shivering. Preterm infants with low body weight find it difficult to maintain the normal body temperature, even in comfortable conditions. Full-term and healthy infants may also be unable to control core body temperature if the ambient temperature is rather low. Babies become hypothermic just by sleeping in a cold room. Neglection of neonatal hypothermia treatment by an infant warmer will lead to serious consequences and complications.

Newborn hypothermia symptoms

Normal rectal temperature in full-term and preterm infants ranges from 36.5 ℃ to 37.5 ℃. If the body index of temperature falls, it is usually assumed that the newborn is hypothermic. They can’t report their discomfort, so it is necessary for doctors to remain vigilant and to recognize when a newborn becomes too cold. If the temperature is below optimal, neonatal hypothermia management procedures must be performed.

What are the symptoms and signs of hypothermia in an infant?

 Cold infants have:

 pale extremities;
 decreased movement;
 poor feeding;
 respiratory difficulty.

 An infant's blood sugar can also be low.

Timely identified symptoms will help to begin neonatal hypothermia management procedures immediately.

Causes of neonatal hypothermia

There are several mechanisms for heat loss:

  • Radiant heat loss: Bare skin is exposed to an environment containing objects of cooler temperature.
  • Evaporative heat loss: Neonates are wet with amniotic fluid.
  • Conductive heat loss: Neonates are placed in contact with a cool surface or object.
  • Convective heat loss: A flow of cooler ambient air carries heat away from the neonate. 

It is important to monitor these moments and take the necessary measures for the subsequent hypothermia treatment in infants and newborns.

Consequences of neonatal hypothermia

Cold stress and hypothermia may have serious metabolic consequences for all infants and newborns. Hypothermia results in a variety of physiological stresses which include: increased oxygen consumption, metabolic acidosis, hypoglycaemia, decreased cardiac output, increased peripheral vascular resistance and respiratory distress. Non-shivering thermogenesis is the main mechanism of heat production in neonates but this has a large caloric demand on the baby, which could lead to hypoglycemia in cold babies.

Hypothermic infants must be rewarmed in an incubator, under a radiant warmer, in an infant warmer or other means must be used.

How to prevent and treat hypothermia in a newborn?

Different types of devices and methods have been developed to actively and passively warm neonates and infants during neonatal hypothermia management:

  • In the delivery room, it is important to start skin-to-skin bonding with the mother if possible; dry the infant, and possibly place a hat on their head.
  • Warm blankets, thermal wraps.
  • Incubators are infant warmers which use warm air circulating in a closed environment to transfer heat through the skin. Humidification is frequently added to minimize cooling and dehydration.
  • Radiant infant warmers provide infra-red radiation which penetrates and transfers heat to the upper skin layers.
  • Heating systems with water or gel mattresses, placed in a baby cot, which warm the baby’s skin surface by conduction. The warming system is a safe and efficient alternative to incubators and radiant infant warmers.

TAHAT offers a heating system with a water mattress or a gel pad to be placed a baby crib – RAMONAK-01.

The system is intended for infants in a stable condition. It’s warming efficiency is the same of a modern incubator. The system provides similar warming and relaxing effect as with skin-to-skin Kangaroo care. The system is versatile and suitable for all newborns.

Ramonak-01 meets latest requirements in all its technical characteristics and capabilities. The systems have been used in everyday medical practice for many years and are the standard equipment in many countries of the world. 

The system allows a newborn to take a comfortable position; creating a relaxing effect and gives easy access to a baby for nurses and parents. The system is equipped with all types of alarms and protections, which prevent overheating and other faulty operations.

This newborn warming system consists of:

▪ Control unit: maintains the set temperature for 24 hours. Audible and visual alarms warn the user about faulty situations.
▪ Heating pad: resistant to wear and tear; as well as to disinfectants. Has 2 built-in temperature sensors. Slim and flexible.
▪ Water mattress: can be used for all babies (preterm, near-term, full-term) from 800 g. Made of medical transparent PVC; UV-resistant. Has a temperature sensor immersed in water.
▪ Gel pad: can be used for near term babies from 1 500 g to full term. Can be used instead of a water mattress. X-Ray translucent; non-conductive. Does not contain latex and fiberglass; hypoallergenic.
▪ Baby bed: prevents infants from sliding off. Water mattress / gel pad and heating pad are placed in a compartment with a zip fastener.






1. Yitayew YA, Aitaye EB, Lechissa HW, Gebeyehu LO. Neonatal Hypothermia and Associated Factors among Newborns Admitted in the Neonatal Intensive Care Unit of Dessie Referral Hospital, Amhara Region, Northeast Ethiopia. Int J Pediatr. 2020 Sep 14; 2020:3013427. doi: 10.1155/2020/3013427. PMID: 33014077; PMCID: PMC7519202.

2. Soll RF. Heat loss prevention in neonates. J Perinatol. 2008 May; 28 Suppl 1:S57-9. doi: 10.1038/jp.2008.51. PMID: 18446179.

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