Evidence-based thermal care of low birthweight neonates. Part one

Neonates are at a high risk of temperature loss. Those born at less than 30 weeks' gestation should be placed in a plastic bag or wrapped immediately at birth, drying the head and putting on a hat, while maintaining routine precautions, such as warming the delivery room, pre-warming surfaces and eliminating draughts. Environmental humidity greater than 50 per cent is required, with up to 85 per cent for extreme prematurity, subject to individual assessment. Using regular or, ideally, continuous monitoring, the child's central (core) body temperature should be maintained at 36.7-37.3 degrees C with a core-peripheral difference, if measured, of 0.5-1 degrees C. Stabilised newborns can be transferred from an incubator into an unheated bassinet or open cot at an optimum weight of > 1.6kg, however individual assessment of each neonate is essential before transferring out of the incubator. In the absence of sufficient research, fully evidence-based recommendations cannot be made and individual unit protocols should be followed with careful clinical judgement. In resource-limited settings--in developing countries around the globe, for example--staff should be trained in simple resuscitation techniques, with keeping newborns warm as a key objective.