Thermoregulation: incubators, radiant warmers, artificial skins, and body hoods

Keeping babies warm whether using incubator or radiant warmers is important in optimizing their chances of survival. Many design changes have occurred in devices for keeping babies warm, while few controlled studies using clinically important end points have been conducted to assess these changes. Radiant warmers produce larger evaporative heat and water losses and slightly higher basal metabolic rate than incubators. The clinical significance of the higher metabolic rate is uncertain. The water losses create an additional problem in managing infants under radiant warmers. The use of hoods made of thin plastic films to raise local humidity and reduce evaporative water loss helps control this problem. In incubators, humidity may be necessary to provide a warm enough environment for the most immature infants. Artificial skins as yet have not supplanted body hoods for this purpose. Both incubators and radiant warmers produce temperature instability when used as skin servocontrolled devices. There are, however, no data currently available to say how much thermal instability can be well tolerated by a baby. Too much thermal instability produces apnea and increased mortality. Air servocontrolling an incubator reduces environmental temperature instability.