Keeping the newborn warm: the warm chain, incubators and radiant warmers, hypothermia and overheating
- Safe practice
Newborns lose heat fast. The nurse links warmth from birth to discharge, uses warmers safely and spots both cold and overheating early.
What it is
A newborn loses heat by evaporation, conduction, convection and radiation, and a small or preterm baby loses it faster. Cold delays the first breath and can keep the lungs' blood vessels tight and the blood acidic. Keeping the baby warm is a chain of linked steps: a warm room, drying, skin-to-skin contact, a cap, a delayed bath and warm transfer. When a baby needs a radiant warmer or an incubator, the nurse sets it up, places the skin probe correctly and checks the baby's own temperature, because a badly placed probe can make the device overheat or underheat the baby.
What it requires
- Four routes of heat loss: evaporation (wet skin), conduction (cold surfaces), convection (air currents) and radiation (cold objects nearby).
- Dry the head and face first and replace the wet cloth with a dry, warm one.
- Delay the first bath until the temperature is stable.
- Servo mode adjusts the heater to a set skin temperature; the skin reading may differ from the axillary one by 0.5 to 1 °C.
Components
- Warm room, pre-warmed towels and a cap.
- Skin-to-skin contact or the kangaroo position.
- A radiant warmer for resuscitation, procedures and term babies who need support.
- An incubator for most preterm or very small babies, sometimes with humidity.
- A thermometer and a record of skin, device and axillary temperatures.
How it is applied (and why)
- Before the birth, warm the room, shut doors and windows and switch fans off — stops convection and radiation losses.
- Dry the baby at once, head first, and swap the wet cloth for a warm one — evaporation is the largest early loss.
- Place the baby skin to skin, cover the exposed skin and put on a cap — the mother's body warms the baby.
- For a baby under 32 weeks, use the plastic bag and radiant warmer without drying the body — limits evaporation in thin skin.
- Measure and record the temperature within the first hour — finds cold or heat before it causes harm.
- Under a radiant warmer, use servo mode, fix the probe on the upper right abdomen and leave only nappy and cap — the heat must reach the skin.
- In an incubator, keep continuous monitoring with alarms, and never cover the probe or let the baby lie on it — a covered probe reads falsely high.
- Check the probe at every set of cares and compare with an axillary reading — a loose probe reads low and the heater overheats the baby.
- When the baby moves to a cot, check the temperature hourly for 4 hours, then every 4 hours — return to the incubator if it drops.
In nursing practice
- Cold stress delays the first breath and can maintain pulmonary hypertension and metabolic acidosis.
- When rewarming, use skin-to-skin contact in a warm room, a cap and covers, and check the blood glucose.
- Signs of overheating: fast heart rate, fast breathing, flushed skin, lethargy and floppiness. Check the probe, the device settings and the clothing.
- A baby who stays cold despite these measures needs medical review.
- A baby with asphyxia who may need therapeutic cooling is not warmed actively; the medical team gives the instructions.
Common mistakes
- Weighing or examining a wet baby away from a heat source.
- Covering the skin probe with a nappy, clothes or a blanket, or letting the baby lie on it.
- Bathing the baby before its temperature is stable.
- Piling on several warming measures at once without checking the temperature: this causes overheating.
- Rewarming a cold baby without checking its blood glucose.
Test yourself
Think of the answer, then tap the question to see it.
What are the four ways a newborn loses heat?
Evaporation, conduction, convection and radiation.
Why must a servo skin probe never be covered by the nappy or lie under the baby?
It reads falsely high, so the heater gives too little heat and the baby can get cold.
What happens if a servo probe comes loose from the skin?
It reads falsely low, so the heater gives too much heat and can overheat the baby.
How is a baby under 32 weeks kept warm at birth?
In a plastic bag up to the neck without drying the body, with the head dried and capped, under a radiant warmer.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Thermal care of the neonate (guideline 970) (NHS Scotland, Right Decision Service (West of Scotland Neonatal Managed Clinical Network), 2026); Thermoregulation for neonates and infants (nursing guideline) (The Royal Children's Hospital Melbourne, 2025); Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal (Ministerio de Salud y Protección Social de Colombia, 2018); Salud sexual y reproductiva: guías para el continuo de atención de la mujer y el recién nacido focalizadas en APS, 3.ª ed. (CLAP/SMR 1577) (Organización Panamericana de la Salud, CLAP/SMR, 2011).
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Representative model, for educational purposes only.