Goals and options in keeping preterm babies warm

More than 50 years after Silverman showed the association between temperature control and mortality, recent data again stress the importance of the thermal environment of the preterm infant. The goals of care are straightforward: maintain a normal body temperature, ensure a stable thermal environment and avoid cold stress; but the options to achieve them are many and less certain. There is a problem in defining a 'normal' temperature. A single measurement will tell nothing about whether the baby is using energy for thermal balance. The preterm baby should be monitored with the continuous recording and display of a central and peripheral temperature. This will give an early indication of cold stress before any change is seen in the central temperature. Reducing evaporative heat losses at birth has improved temperatures on admission, although no studies have shown any effect on outcome. No data have shown that the use of incubators is any better than radiant heaters.