Thermoregulatory Bundle With Local Specifications for Delivery Room Stabilization

Type of Heat LossCommon CausesPrimary Interventions Specified in Bundle
ConductionDirect contact with cold bed surfacesTurn on radiant warmer when delivery is anticipated to prewarm resuscitation bed.30,34,37
Make additional prewarmed blankets available for transfer.
RadiationLarge skin surface area exposed to cooler surroundings; blockage of radiant heat sourceTurn warmer on early and close door to selectively warm the separate resuscitation room (when available).14,15
Lean back, do not block infant’s access to heat.
Set servo-controlled warmer to 37°C by 5 min of age (in phase 2).
EvaporationWet skin or nonocclusive wrappings; low humidity of ambient air or inspired gasRapidly blot off excess fluid and blood; no need to dry completely.38
Apply plastic wrap to head immediately.39,40
Apply stockinette hat over the plastic wrap.
Apply plastic wrap around body of infant when <29 wk gestational age.22,38
Auscultate through undisturbed plastic wrap.
ConvectionCool air flowing over skin; cold gases flowing over mucous membranesIncrease temperature of stabilization room using warmer.
Reduce air drafts by closing door, raising sides of warmer; keep all sides up and use additional blankets, with only face exposed, for transfer.41
Keep baby's skin covered with plastic wrap; add large blanket for transfer.15
Transfer to prewarmed, humidified incubator on admission (after temperature measured).
  • Adapted from the basic steps in the Neonatal Resuscitation Program, aiming to minimize all 4 physical mechanisms of heat loss. References indicate key published evidence or rationale for the bundle elements.