Abstract
Mathematical models of body heat exchanges can be used to define the thermal limits needed to protect premature neonates nursed in incubators against thermal stress–stress that can have potentially devastating impairments on neurological development and body growth. Predictive models can help caregivers to keep a neonate’s body temperature within the normal range and to solve problems that arise during intensive care, such as the risk of hyperthermia during phototherapy, the risk of hypothermia during transport from one clinical centre to another, and the use of a plastic bag to reduce skin water loss and body dehydration. Here, we review the strengths and limitations of models used to predict the risk of thermal stress, with a focus on uncertainties in the algorithms governing heat transfers between the neonate’s skin and the complicated thermal environment encountered in incubators. We describe attempts to reduce the large number of empirical assumptions and uncertainties in this field, and suggest ways of more accurately modelling optimal thermal conditions for neonates nursed in closed incubators.
Highlights
IntroductionOptimizing a premature neonate’s thermal environment is still a challenge in routine clinical care
Optimizing a premature neonate’s thermal environment is still a challenge in routine clinical care.There are several reasons why poorly effective thermoregulatory responses to thermal changes increase the risk of thermal stress in preterm infants
Interest in using mathematical models of body heat exchanges is growing steadily, despite the fact that the complex equations describing these exchanges have to be simplified for successful implementation
Summary
Optimizing a premature neonate’s thermal environment is still a challenge in routine clinical care. There are several reasons why poorly effective thermoregulatory responses to thermal changes increase the risk of thermal stress in preterm infants. Body heat exchanges with the environment are larger in infants than in adults as a result of the high skin surface area/body volume ratio and the body segments’ high degree of curvature. When exposed to low ambient temperatures, the neonate reduces its peripheral blood flow and increases the metabolic heat production. This mechanism decreases the energy available for tissue synthesis and impairs body growth. The pathological effects of thermal stress in neonates are devastating, and include severe impairments in neurological development and body growth. Given the complexities of the body’s thermoregulatory system and the simplifications needed to describe the various heat transfers between the skin surface area and the environment, care providers do not yet trust these models to make accurate predictions
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