Postnatal stabilisation is a key aspect of the beginning of extrauterine life. The latest recommendations of the International Liaison Committee on Resuscitation (ILCOR, 2015)1 and the Group on Neonatal Resuscitation of the Sociedad Española de Neonatología (Spanish Society of Neonatology, SENeo)2 underscore the importance of maintaining a body temperature within the normal range (36.5–37.5°C) in all newborns that are not experiencing asphyxia. Compared to adults, newborns need a higher temperature in the environment to maintain their body temperature, especially if they have been born preterm or in a compromised condition. Body temperature at admission in the neonatal unit is a predictor of morbidity and mortality and is especially relevant in extremely preterm newborns.3 Hypothermia causes hypoxia, metabolic acidosis, increased breathing difficulty and hypoglycaemia, and has been associated with an increased incidence of late-onset sepsis, retinopathy of prematurity, bronchopulmonary dysplasia, necrotising enterocolitis and intraventricular haemorrhage.1–5 It has been reported that in preterm newborns with birth weights less than 1500g, for every degree Celsius that the admission temperature decreases below 36.5°C, mortality increases by up to 28% and the risk of late-onset sepsis by up to 11%.3 Given the dire consequences of hypothermia, resuscitation guidelines recommend early and effective interventions to prevent it in newborns.1,2,6 It is also important to avoid hyperthermia (a body temperature>38°C), as it has been associated with increased respiratory depression, neonatal seizures, early mortality and cerebral palsy.1,2

The admission temperature of the patient must be recorded in the health record and is considered a health care quality indicator.

After reviewing the records of our hospital and finding that this recommendation was rarely met, in January 2016 measures were introduced to prevent decreases in body temperature in the delivery room and the first hour post birth, which are detailed in Table 1. All the involved staff were informed of the proposed improvement measures (obstetricians, midwives, neonatologists, anaesthesiologists, nurses, health care technicians and maintenance staff). One year after introducing these measures, we conducted an observational study in which we reviewed the axillary temperatures recorded at admission in the health records of newborns delivered before 35 weeks’ gestation. We excluded patients transferred from other hospitals. We defined normothermia as an axillary temperature of 36.5–37.5°C.

In the previous 8 years (2008–2015), the mean axillary temperature at admission and the percentage of patients admitted with a normal temperature were similar, so we only show the results for 2015. Table 2 compares a retrospective cohort of patients born at gestational ages of less than 35 weeks in 2015 with another prospective cohort of infants born in 2016, when the improvement measures aimed at maintaining normothermia in the first hour of life had already been introduced. We performed the statistical analysis with the SPSS® package version 20.0. We compared means using the Student t test for independent samples and percentages with the chi square test. We defined statistical significance as a p-value of 0.05 or less.

In years 2015 and 2016, 54.7% of admitted patients had been born before 35 weeks’ gestation. In 2015, the mean axillary temperature at admission was 35.9°C±0.7°C, and only 20.9% of these patients had a normal body temperature at admission. However, in year 2016, after the introduction of the improvement measures, the percentage of patients admitted with a normal temperature rose to 58.1%, and the mean admission temperature to 36.8°C, differences that were statistically significant. In the subset born before 32 weeks’ gestation, a group in which neonatal resuscitation guidelines emphasise the importance of maintaining normothermia, the impact of the improvement measures was even greater, with the target temperature range achieved in 70% of cases. This percentage was also achieved in the subset corresponding to the most vulnerable premature babies, those born before 28 weeks’ gestation.

The increase of the percentage of preterm patients admitted with a normal temperature is attribute to the awareness of the whole staff about the vulnerability of these patients adn their strict adherence to the adopted improvement measures. Nevertheless, we believe we ought to emphasise the importance of pursuing normothermia in all newborns without asphyxia, independently of gestational age.

In conclusion, we confirmed that the measures introduced to prevent decreases in body temperature in the delivery room and the first hour post birth have been effective. In spite of the improvement observed, it is necessary to continuous our efforts in order to achieve normothermia at admission in all newborns.