Neonatal hypothermia occurs when a newborn’s body temperature drops below 36.5°C (97.7°F). i A significant increase in neonatal mortality is associated with each 1°C reduction in body temperature.i Loss of body heat can occur due to cold environments or failure to immediately dry and wrap the infant after birth. Because pre-term and low-birth-weight babies have smaller amounts of the fat that helps to generate heat, they are at greater risk for hypothermia.ii
The World Health Organization states that, “Every year, more than 20 million infants are born weighing less than 2500g—over 96% of them are in developing countries. These low-birth-weight infants are at increased risk of neonatal morbidity and mortality.”iii While kangaroo mother care (prolonged skin-to-skin contact between mother and newborn), is the preferred method of preventing and addressing newborn hypothermia, it is not always possible.
Thermoregulation technologies are an important complement to kangaroo mother care by improving the health outcomes of preterm and sick neonates. While incubators provide the most advanced warming technology, they are often prohibitively expensive and do not allow easy access to the infant. Further, there can be a risk of infection when using an incubator. Not only must the unit be thoroughly cleaned and disinfected at regular intervals, but also the water in the reservoir must be changed frequently to prevent the growth of microorganisms.iv Recent research also shows that the warm, humidified air inside the incubator encourages microbial growth inside the incubator under certain environmental conditions.v Therefore, other technologies may be better options for lowresource settings. Warming beds provide easy access to the infant both for feeding and changing, and also for performing medical examinations and procedures without decreasing the amount of heat being provided to the infant. More expensive warmers may also include x-ray capabilities within the bed, thereby preventing the infant from needing to be moved for such tests. However, warming beds can increase dehydration, so the infant must be closely monitored at all times and daily fluid requirements must be calculated accordingly.vi Other types of warming and heat stabilization through heated mattresses and wraps can also be effective methods of thermoregulation depending on the age, weight, and health of the infant.
Several thermoregulation devices have recently been developed in Southeast Asia which are specifically marketed and priced for low-resource settings and include training for end-users on the repair and maintenance of the device.
In 2009, PATH convened a panel of neonatologist to review the most important characteristics for warming devices in low-resource settings. These experts outlined 19 factors important to warming devices for transport and 18 factors important to warming devices for facility-based care. These factors are outlined in the following summary of neonatal warming technologies.vii This guide contains commercialized devices that are available on the market today.
The guide is organized by device type—1) infant radiant warmer beds, 2) exothermic mattresses, and 3) occlusive wraps—and then by price within each category. Some devices are appropriate for facility use only, some for transportation only, and some for both. Criteria for transportation or facility-specific criteria are excluded if there were none