• Use axillary route
• Measure temperature on admission, within ≤60 min of birth, then
• Hourly until stable, then 3–4 hrly 
  • more frequently if required due to clinical condition
  • 6-hrly when baby stable and on 3-hrly feeds 
• Babies with poor perfusion (or on medical request) – monitor core peripheral temperature difference continuously using temperature probes on chest and foot 
  • difference of >2°C suggestive of poor perfusion

• Normal: 36.5–37.5°C
• Hypothermia: <36.5°C
• Low grade fever: 37.6–37.9°C
• Fever: ≥38°C

• Hypothermia, fever and temperature instability can be signs of serious illness
• If baby unwell, irrespective of body temperature, notify medical staff/ANNP
• Beware of unusual temperature behaviours e.g.:
  • hypothermia in term baby
  • fever in preterm baby

Follow BAPM QI Toolkit for prevention of hypothermia in preterm babies − https://www.bapm.org/pages/105-normothermia-toolkit

Risks and consequences

• Babies <32 weeks’ gestation, low-birth-weight, small-for-dates and sick babies are at particular risk of hypothermia 
• Adverse effects associated with hypothermia include:
  • hypoglycaemia
  • hypoxia and metabolic acidosis
  • respiratory distress and chronic lung disease
  • necrotising enterocolitis
  • intraventricular haemorrhage
  • late onset sepsis
  • death

Delivery suite

• Keep room 23–28°C and free from draughts, especially when delivery imminent 
  • aim for room temperature on the higher side for all premature babies (particularly IUGR)
• Pre-warm resuscitaire and towels with heater at 100%

Babies <32 weeks

• Place baby on resuscitaire, dry head only
  • place baby’s body in plastic bag
  • place hat on baby’s head
• Take temperature before moving baby to NNU
• Transfer to NNU with suitable thermal support

Other babies

• Use pre-warmed towels. Dry immediately, discard towel and wrap in another towel and blanket
• Ensure room warm enough to enable skin-to-skin contact and early breastfeeding
• Cover exposed skin with warm blanket
• Avoid giving bath immediately after birth

Neonatal unit

• Keep at 24–25°C to avoid cooling from radiant heat loss, and ‛misting’ (condensation) in incubators
• Keep incubators and cots away from windows to prevent radiation heat loss
• Nurse babies requiring intensive care in pre-warmed incubator
• For very premature babies, use humidification in incubator
• If respiratory support e.g. high flow oxygen therapy, CPAP or ventilation anticipated ensure humidifiers are turned on and set temperature of 37°C achieved 
• Do not leave incubator portals open for longer than necessary
• Avoid excessive wrapping/clothing of babies in cots

Incubator temperature during first 3 days

• Babies <1000 g may require higher temperatures, occasionally >37°C 
• If baby’s temperature remains within normal limits for 24 hr, reduce incubator temperature according to baby’s needs
• When baby’s weight reaches approximately 1600 g, transfer to open cot

Babies not at risk of hypothermia

• If not requiring observation of respiratory status or invasive procedures, babies may be dressed, wrapped and placed in a cot

• Mild hypothermia can be managed with the addition of:
  • hat 
  • heated mattress 
• If baby’s temperature <36.0°C consider:
  • use of incubator, if available 
  • increasing humidity, if appropriate for gestational age
  • bubble wrap
  • skin-to-skin 
• Recheck temperature in 1 hr
• Baby to be reviewed by medical team

• Rewarm in incubator
  • ≥1200 g, rewarm at 1°C/hr
  • <1200 g, rewarm more slowly

• Heated pads (Transwarmer) should not be used if another heat source (incubator heater, radiant heater, heated mattress etc.) is already in use
• If units choose to continue to use Transwarmers in conjunction with radiant heat to prevent newborn hypothermia, strict vigilance must be given to:
  • ensuring skin integrity
  • avoiding hyperthermia by continuous temperature monitoring
  • limiting duration of use