The Warm Chain: Preventing Hypothermia In Newborns

Written by
DiaMedical USA
Published on April 22, 2022 2:03:00 PM PDT April 22, 2022 2:03:00 PM PDTnd, April 22, 2022 2:03:00 PM PDT

Maintaining a neutral thermal environment is one of the most important challenges that newborns face after delivery. Clinicians can greatly reduce neonatal morbidity and mortality by minimizing heat loss during the first few hours of life. This blog will explore how the warm chain can be used to protect newborns from the dangers of hypothermia. 


Heat loss at birth 

Newborns rapidly lose body heat immediately after birth, primarily from evaporation of amniotic fluid. During the first 10 to 20 minutes of life outside of the womb, their body temperature can drop by 2-4°C. The smaller or more premature the newborn is, the greater the risk of heat loss.  

If no warming actions are taken, infants quickly develop cold stress with vasoconstriction, hypoxia and hypoglycemia. Neurological complications, hyperbilirubinemia, clotting disorders and even death may result if hypothermia is not treated promptly. Clinicians should monitor the infant’s temperature with an axillary thermometer or skin sensor to ensure that it stays between 36.5 and 37.5° C. Shivering is a late indicator of hypothermia as it will not begin until the infant’s temperature has dropped to 32-34°C. Furthermore, preterm infants are unable to shiver in response to cold because of their immature muscles. 


The warm chain

The warm chain is a set of procedures that are performed at birth and during the next few days in order to minimize heat loss in newborns (1). A break in any link of the chain puts the infant at risk of hypothermia. These steps include: 

  • Ensure that the delivery room is at least 25°C and free from drafts, with a radiant warmer ready for use.  
  • Immediately dry the newborn after birth with a warm towel and place it skin-to-skin on the mother’s chest. Cover the newborn with a fresh warm towel and place a cap on its head.  
  • If assessment or resuscitation is required, the infant should be placed under a radiant warmer with skin temperature monitoring.


Infant warmers

All hospitals that care for sick and low birth weight infants should have radiant infant warmers with skin temperature sensors. Modern infant warmers have electronic quartz heating elements that provide infrared energy with minimal visible light. They heat up very quickly and reach full output in as little as 30 seconds. Microprocessors within the warmer maintain the skin temperature using a sensor on the infant’s abdomen. For safety, audible and visible alarms indicate if the infant’s temperature is above 39°C or if the sensor becomes disconnected.  

Finally, an essential feature of quartz heaters is that they allow supplemental oxygen to be administered to the infant without the risk of fire.  


SimLabSolutions 7013 Radiant Infant Warmer

The new SimLabSolutions 7013 Infant Warmer was designed for healthcare education and includes all of the same features that students will use during their clinical rotations. It has a silica quartz infrared lamp with a parabolic reflector to provide fast, complete, even heating. Preheat, automatic, and manual control modes are provided so students can realistically practice neonatal temperature management. An integrated timer is even included to remind students to record the infant’s APGAR scores at 1 minute, 5 minutes, and 10 minutes. The mattress area has a weight capacity of 22 kg that will accommodate all types of low and high-fidelity infant manikins. For interdisciplinary simulations with radiology students, an x-ray board can be inserted and removed from either side.

 Final thoughts

Preventing hypothermia in the newborn is important in order to avoid serious and potentially life-threatening complications. The warm chain was created to provide thermal protection and help them maintain normal body temperatures. A radiant infant warmer is an essential component of this chain for premature or sick newborns. The DiaMedical USA team is ready to help schools balance cost and functionality in order to find the best infant care supplies for their programs. For more information, reach out to a DiaMedical USA expert at 877-593-6011 or  



World Health Organization. (1997). Thermal protection of the newborn: A practical guide. Retrieved from;jsessionid=1595368C6B3D3201D53ACBC8ED3310C9?sequence=1