Advances in Neonatal Care:
Editorial: Letter From the Editor
This month we are pleased to offer this supplement, which contains 3 articles highlighting the importance of thermoregulation and heat loss prevention in preterm infants. Why thermoregulation you might ask. Don't we already know all about that? We have known the importance of keeping premature babies warm for a long time. In fact, premature infants were placed in incubators perhaps as early as 1835.1
One of the first things we are taught when orienting to the neonatal intensive care nursery (NICU) is the principle of thermoregulation. The chapter on thermoregulation is located near the beginning of most neonatal nursing textbooks. Consequently, it is a subject that most NICU nurses would say they are familiar with and may even consider themselves an expert in. However, despite this education, and the fact that we deal with thermoregulation every day in the NICU, it continues to be a challenge. As the authors of these manuscripts point out, thermoregulation continues to be a problem, even in level III perinatal centers where low birth-weight infants are cared for on a regular basis. In fact, in 2 of these articles, it was noted that low birth-weight infants had significant periods where their temperatures were well below normal. These periods of hypothermia happened during stabilization and during routine caregiver procedures. The third article illustrates the effect of seasonal temperature differences and the influence on nursery ambient conditions. This demonstrates the need for ongoing assessment and attention to the neonate's environment.
Why does this continue to be a problem, despite education regarding the principles of thermoregulation and fact that we deal with it on a daily basis in the NICU? Some of it is because of the thin skin, lack of subcutaneous fat, and immature responses of the low birth-weight and preterm infant. But it may also be partly because accidents and errors do not happen most frequently when doing something we have never done before. In fact, errors are more common when we are doing things that are routine; where we know, or think we know what we are doing.2 Contrary to the popular belief, it is often the most expert clinicians who make errors or mistakes. Sometimes, the more “routine” a procedure is, the more likely we are to forget parts, become sloppy, or be distracted by unusual events or occurrences. Because we learn the principles of thermoregulation early in our careers and then practice it daily, we actually forget the main points or give it little attention. But the fact that this is a principle for beginners does not mean that we don't have to think about it. In 2010, cold stress continues to be a problem that requires our attention. I hope that you will review these articles and think about the daily practices in your units that can be improved. Our infants depend on optimal thermal care from all NICU providers.
2. Reason J. The Human Contribution. Unsafe Acts Accidents and Heroic Recoveries-. Burlington, VT: Ashgate Publishing; 2008.