Thermal management of the low birth weight infant: A cornerstone of neonatology  

Oleh:

Narendran, Vivek ; Hoath, Steven B.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The Journal of Pediatrics vol. 135 no. 05 (Nov. 1999), page 529-531.
Topik: LBW ; Low birth weight

Ketersediaan

Perpustakaan FK Nomor Panggil: J45.K.1999.02 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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At birth, the body temperature of the newborn infant will approximate or slightly exceed that of the mother. Within minutes of birth, however, core temperature begins to fall, particularly in infants with birth weights <1500 g. These infants have a diminished capacity for metabolic heat production coupled with a high surface area to volume ratio and an immature epidermal barrier, leading to extraordinarily high evaporative heat losses. Consequently, low birth weight infants are highly vulnerable to the development of cold stress. In the late 1950s, Silverman et al demonstrated that maintenance of body temperature through control of the thermal environment significantly reduced mortality in LBW infants. This study was subsequently replicated by other investigators with the result that thermal management became a cornerstone of the new field of neonatology. Focus on thermal management of the newborn led to a series of controversial topics surrounding the broad issue of coupling between the infant and the postnatal environment. The provision of humidity, for example, was quickly recognized as an important element in controlling heat losses, but concerns were raised that humidified environments increased nosocomial infections by microorganisms such as pseudomonads. This controversy is still unresolved. Similarly, debate arose regarding the optimum mode of preventing heat loss to the very LBW infant. The 2 primary modes of thermal management rest on control over the convective environment versus control of radiant losses. Proponents of radiant warming point out the need for ready accessibility and visibility in care of LBW and sick newborns, whereas detractors note increased transepidermal water loss and possible increases in metabolic rate compared with convective incubators. Radiant warmers must always be servocontrolled to the skin temperature, whereas incubators exhibit more versatility and can be controlled by means of feedback from the skin, the air, or a combination of control parameters. Radiant warmers (set to the maximum attainable power output) are the standard mode of thermal management in most US delivery rooms. Consequently, high evaporative heat loss is anticipated during the period of early infant stabilization.

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