Hypothermia

Staged excision and grafting remains the mainstay of the surgical treatment of large burn injuries since Jackson and colleagues demonstrated a decreased mortality with excisions of 20% or less in 1960 [1]. The major factors limiting these excisions are blood loss and hypothermia. Despite these known limitations, little progress had been made in combating the hypothermia that comes with a large excision. The current re-warming strategies include: increasing ambient room temperature, infusing warm intravenous fluids, and using hot air technologies such as the Bair Hugger TM , but no single solution or combination of solutions has proven adequate [2]. Recently at our institution, a new intravascular warming catheter was used to perform a large burn excision with excellent results.

A case description is presented of a 9-member rowing team whose scull swamped on a small lake in Victoria, Canada, because of a sudden winter storm, which immersed them in 4ЊC water for 50 minutes until a small rescue boat found them in darkness. Another 13 minutes of cold exposure in 6.7ЊC air occurred during boat transport to waiting ambulance paramedics. Two rowers died, one from severe hypothermia and the other from drowning as a consequence of cold incapacitation and hypothermia. The 2 coldest rowers, who were transported 8 km to a major hospital, arrived with rectal temperatures of 23.4ЊC and 25ЊC; the first was asystolic and the second was unconscious and in sinus bradycardia. Analysis of all the circumstances of this incident provided an opportunity to observe a continuum of responses in a heterogeneous group of rowers at risk of severe hypothermia. Several practical lessons concerning cold-water survival, rescue, and treatment can be learned. The effects of low body mass were associated with greater cooling rate. Diminished neuromuscular performance in the periphery appeared to be independent of body mass. Rough handling during moving of patients with marked hypothermia introduces the risk of producing ventricular fibrillation or cardiac arrest. Unconscious, nonshivering hypothermia victims who are rescued and insulated from cold could have a further afterdrop of 3ЊC to 4ЊC. During transport to a hospital, the use of heating devices concentrating on core regions may increase the chance of successful treatment in the hospital. Cardiopulmonary bypass may be indicated for severely hypothermic patients in asystole.

We study a resistive-heating blanket in a volunteer model of severe accidental hypothermia to evaluate differences in rates of rewarming, core temperature afterdrop, and body heat content and distribution during active and passive rewarming.

Pressurised infusion devices may have only limited capability to detect and remove air during pressurised infusions. In order to assess pressure infusion systems with regard to their actual air elimination capabilities four disposable pressure infusion systems and fluid warmers were investigated: The Level 1Ò (L-1), Ranger Ò (RA), GymarÒ (GY), and the WarmfloÒ (WF). Different volumes of air were injected proximal to the heat exchanger and the remaining amount of air that was delivered at the end of the tubing was measured during pressurised infusions. Elimination of the injected air (100-200 ml) was superior by the RA system when compared to L-1 (p < 0.01). The GY and WF systems failed to eliminate the injected air. In conclusion, air elimination was best performed by the RA system. In terms of the risk of air embolism during pressurised infusions, improvements in air elimination of the investigated devices are still necessary.

Shapiro syndrome is a rare entity, comprising a triad of recurrent hypothermia, hyperhidrosis and congenital agenesis of the corpus callosum. Fewer than 50 cases have been described, almost invariably in patients presenting in childhood or early adulthood. We present a case of an 80 year old woman presenting with recurrent bouts of shivering, sweating and profound malaise, who sought medical attention because the frequency and severity of attacks worsened in her later years. MRI Brain demonstrated agenesis of the corpus callosum; a rigorous work-up excluded other causes for her symptomatology. The intricate interplay of neuronal networks involved in thermoregulation remains to be fully elucidated and as such, little is known about the pathophysiological mechanisms underlying the clinical manifestations of Shapiro syndrome. We present novel data from FDG-PET imaging of our patient, demonstrating hypermetabolism in a number of brainstem and cerebellar regions during the symptomatic phase. These findings imply that aberrant thermoregulation in Shapiro syndrome involves a number of structures remote from the callosal region. We also present neuropsychometric findings in our patient, of which there have been no reports to date. We postulate that the ageing brain may be more susceptible to the paroxysmal neurochemical fluxes implicated in the syndrome.

This study examines the incidence, predictors, and evolution of postoperative atrioventricular block (AVB) after mitral valve repair (MVR) in 115 consecutive patients using Carpentier's technique (between November 1996 and April 1997). Postoperative AVB occurred in 27 patients (23%). Third-degree AVB was found in 7 patients (6%) in the immediate postoperative period, but in 4 it was transient, resolving partially or completely before the seventh postoperative day. Second-degree AVB (Mobitz type I) occurred in 4 patients (3%) immediately after operation and resolved in all before hospital discharge. Isolated first-degree AVB occurred in 16 patients (14%) and was permanent in 12. Neither the preoperative variables nor the mitral procedures including anterior versus posterior leaflet repair were related to postoperative AVB. A lesser systemic hypothermia during surgery was the only, modestly independent predictor of postoperative AVB (odds ratio 1.53; 95% confidence interval 1.04 to 2.25; p ‫؍‬ 0.031). Three patients (2.6%) had permanent pacemaker implantation, on average 18 days after operation, and all had persistent third-degree AVB. With a mean follow-up of 3 years, no recurrence or worsening of conduction disturbances, no further pacemaker implantation, and no late deaths were observed. ᮊ2002 by Excerpta Medica, Inc.

Background and objectives: Risk analysis for medical devices is a crucial process to grant adequate levels of safety. Identification of device exposure-related hazards is one of the main objectives. Design, setting, participants, & measurements: Hazard analysis for hemodialysis devices has been performed by a multidisciplinary team involving engineers and clinical experts. A potential harm list was identified from clinical and technical experience, postproduction information, and literature. Various hazardous situations (circumstances when the use of the dialysis device may lead to described harms) were described. Such hazardous situations were correlated to the extent of the deviation of a specific device parameter from expected ranges. The clinical severity that was relevant to any specific harm was categorized for each hazardous situation using a descriptive and numerical scale with five levels (from negligible [i.e., discomfort only] to catastrophic [i.e., potentially lethal]). Results: Harms in which the deviation of a parameter strictly coincides with the clinically measured effect on the patient are defined as "direct." Otherwise, when another clinical parameter must be involved to quantify severity, the related harm is considered "indirect." Two complete examples of multidisciplinary evaluation for severity of hazards (MESH) are given for a direct harm (air embolism) and for an indirect harm (hypothermia). For other harms, the maximum value of severity involved is provided. Conclusions: MESH represents a possible example of risk management for dialysis equipment in which, although the manufacturer is directly responsible, a multidisciplinary task force may contribute to a better link between engineering and clinical perspectives.

This survey addresses the immediate physiological reactions to immersion in cold water: cold shock response, diving reflex, cardiac arrhythmias and hypothermia. Cold shock response is the initial sympathetic reaction to immersion in cold water. The diving reflex is elicited by submersion of the face. Afferent and efferent nerves are the trigeminal and vagal nerves. Cardiac arrhythmias occur immediately after immersion. If the immersion persists, hypothermia becomes an issue. Hypothermia is delayed by habituation to immersion in cold water as well as insulating garments, subcutaneous fat and a large lean body mass.

Adenosine is an important neuromodulator and neuroprotective molecule, which is produced in the brain as a function of neuronal activity, coupling energy expenditure to energy supply. Under conditions of increased need and reduced availability of energy, including hypoxia and prolonged wakefulness, there is an increase in adenosine turnover and adenosine receptor stimulation. The aim of the present study was to examine how repetitive adenosine receptor stimulation affects receptor function and adenosinergic signaling in the brain. Adult male Wistar rats received daily intraperitoneal injections of the adenosine A1 receptor agonist N 6 -cyclopentyladenosine (CPA; 0.25 mg/kg; once per day) and effects on adenosine signaling were established with receptor and G-protein autoradiography. Injections of CPA for 5 consecutive days caused a significant decrease in adenosine A1 receptor numbers in the hippocampus and somatosensory cortex. In contrast, while the amount of adenosine A1 receptor-activated G-proteins was not affected in most regions, a significant increase was found in the somatosensory cortex. On the level of physiological output, CPA-induced hypothermia was significantly attenuated, suggesting a functional desensitization of the A1 receptor system. Taken together, the present findings suggest that repetitive stimulation of the A1 receptors can affect elements of the adenosinergic signaling cascade in the rat brain in a region-specific manner. ava i l a b l e a t w w w. s c i e n c e d i r e c t . c o m w w w. e l s ev i e r. c o m / l o c a t e / b r a i n r e s

BACKGROUND CONTEXT: Interest in systemic and local hypothermia extends back over many decades, and both have been investigated as potential neuroprotective interventions in a number of clinical settings, including traumatic brain injury, stroke, cardiac arrest, and both intracranial and thoracoabdominal aortic aneurysm surgery. The recent use of systemic hypothermia in an injured National Football League football player has focused a great deal of attention on the potential use of hypothermia in acute spinal cord injury. PURPOSE: To provide spinal clinicians with an overview of the biological rationale for using hypothermia, the past studies and current clinical applications of hypothermia, and the basic science studies and clinical reports of the use of hypothermia in acute traumatic spinal cord injury. STUDY DESIGN/SETTING: A review of the English literature on hypothermia was performed, starting with the original clinical description of the use of systemic hypothermia in 1940. Pertinent basic science and clinical articles were identified using PubMed and the bibliographies of the articles. METHODS: Each article was reviewed to provide a concise description of hypothermia's biological rationale, current clinical applications, complications, and experience as a neuroprotective intervention in spinal cord injury. RESULTS: Hypothermia has a multitude of physiologic effects. From a neuroprotective standpoint, hypothermia slows basic enzymatic activity, reduces the cell's energy requirements, and thus maintains Adenosine Triphosphate (ATP) concentrations. As such, systemic hypothermia has been shown to be neuroprotective in patients after cardiac arrest, although its benefit in other clinical settings such as traumatic brain injury, stroke, and intracranial aneurysm surgery has not been demonstrated. Animal studies of local and systemic hypothermia in traumatic spinal cord injury models have produced mixed results. Local hypothermia was actively studied in the 1970s in human acute traumatic spinal cord injury, but no case series of this intervention has been published since 1984. No peer-reviewed clinical literature could be found, which describes the application of systemic hypothermia in acute traumatic spinal cord injury.

Background: Serious sequelae have been associated with injured patients who are hypothermic (<35 • C) including coagulopathy, acidosis, decreased myocardial contractility and risk of mortality. Aim: Establish the incidence of accidental hypothermia in major trauma patients and identify causative factors. Method: Prospective identification and subsequent review of 732 medical records of major trauma patients presenting to an Adult Major Trauma Centre was undertaken between January and December 2008. Multivariate analysis was performed using logistic regression. Significant and clinically relevant variables from univariate analysis were entered into multivariate models to evaluate determinants for hypothermia and for death. Goodness of fit was determined with the use of the Hosmer-Lemeshow statistic. Main results: Overall mortality was 9.15%. The incidence of hypothermia was 13.25%. The mortality of patients with hypothermia was 29.9% with a threefold independent risk of death: OR (CI 95%) 3.44 (1.48-7.99), P = 0.04. Independent determinants for hypothermia were pre-hospital intubation: OR (CI 95%) 5.18 (2.77-9.71), P < 0.001, Injury Severity Score (ISS): 1.04 (1.01-1.06), P = 0.01, Arrival Systolic Blood Pressure (ASBP) < 100 mm Hg: 3.04 (1.24-7.44), P = 0.02, and wintertime: 1.84 (1.06-3.21), P = 0.03. Of the 87 hypothermic patients who had repeat temperatures recorded in the Emergency Department, 77 (88.51%) patients had a temperature greater than the recorded arrival temperature. There was no change in recorded temperature for four (4.60%) patients, whereas six (6.90%) patients were colder at Emergency Department discharge. Conclusion: Seriously injured patients with accidental hypothermia have a higher mortality independent of measured risk factors. For patients with multiple injuries a coordinated effort by paramedics, nurses and doctors is required to focus efforts toward early resolution of hypothermia aiming to achieve a temperature >35 • C.

A series of new benzimidazole-arylpiperazine derivatives III were designed, synthesized and evaluated for binding affinity at serotoninergic 5-HT 1A and 5-HT 3 receptors. Compound IIIc was identified as a novel mixed 5-HT 1A /5-HT 3 ligand with high affinity for both serotonin receptors and excellent selectivity over a 1 -adrenergic and dopamine D 2 receptors. This compound was characterized as a partial agonist at 5-HT 1A Rs and a 5-HT 3 R antagonist, and was effective in preventing the cognitive deficits induced by muscarinic receptor blockade in a passive avoidance learning test. #

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Following accidental immersion in cold water, the chance of survival through the initial short-term period may depend on manual dexterity for survival tasks. We aimed to study the time course of impairment of manual dexterity during the initial stages of immersion. We investigated gross (manipulating harness buckles) and fine (Purdue Pegboard Assembly) manual dexterity of 11 male and 15 female subjects with either no immersion (Control) or after immersion of right and left hand and forearm in 10 degrees C water for 30, 120, and 300 s. Exposure lengths were presented in a counter-balanced order in a single session. Mean local skin temperature decreased significantly with cold-water immersion, with the amount of cooling proportional to the length of exposure. Buckle test times increased significantly from 9.1 +/- 3.0 s during Control to similar values of 19.5 +/- 11.1 s and 18.14 +/- 12.1 s after 120 and 300 s of immersion. Pegboard scores were significantly lower at 40.2 +/- 7.6 piec...

Jedes Jahr versterben in Nordamerika und Europa etwa 140 Personen durch Lawinen, ca. 35 in Nordamerika, etwa 100 in den europäischen Alpen und ca. 5 in anderen Gebieten Europas. Die meisten Verschütteten sind Skifahrer und „snowboarder“. Der vorliegende Artikel beleuchtet die spezielle Pathophysiologie bei einer Lawinenverschüttung, wie Hypoxie, Hyperkapnie und Hypothermie, des Weiteren die Faktoren, die auf das Überleben Einfluss nehmen. Strategien zur Verminderung der Letalität bei einem Lawinenabgang und die präklinische Therapie eines Verschütteten werden besprochen. Abschließend werden Möglichkeiten zur Verringerung der jährlichen Anzahl von Lawinentoten dargestellt. In North America and Europe around 140 persons die every year due to avalanches, approximately 35 in North America, 100 in the European Alps, and 5 in other parts of Europe. Most of the victims are skiers and snowboarders. This article outlines the specific pathophysiology of avalanche burials, such as hypoxia, hypercapnia, and hypothermia and also other factors which influence survival. Strategies to minimize the mortality due to avalanches and the on-site treatment of buried persons are discussed. Finally, possibilities to reduce the number of avalanche deaths are pointed out.

To determine whether or not participants in open water swim events experience hypothermia and afterdrop, rectal temperature was measured for up to 45 minutes in 11 subjects following the New Year's Day Alcatraz Swim. This event was held in open water (11.7°C [53.0°F]) in the San Francisco Bay, and participants did not wear wetsuits or other protective clothing. Biophysical parameters, including surface/volume ratio, body mass index, and percent body fat were measured before the swim, and statistical analysis was done to determine predictors of temperature decrease and afterdrop duration. Applying the American Heart Association definition of hypothermia (less than 36.0°C [96.8°F]), hypothermia was seen in 5 of the 11 subjects. Using a more rigorous and traditional definition (less than 35.0°C [95.0°F]), hypothermia was seen in only one subject. Afterdrop, defined as continued cooling following removal from cold stress, was seen in 10 of the 11 subjects. Surface/volume ratio (S/V) and body mass index (BMI) predicted the lowest recorded temperatures (P < .05; r(S/V) = −.71, r(BMI) = .72) and afterdrop duration (P < .05; r(S/V) = −.75, r(BMI) = .69). These results suggest that hypothermia and afterdrop can occur commonly after recreational open water swimming, and that participants should be observed for signs of temperature decrease following removal from cold stress. (Am J Emerg Med 2000;18:703-707.

Background Inadvertent hypothermia is common in patients undergoing surgical procedures with a reported prevalence of perioperative hypothermia ranging from 50% to 90%. Hypothermia within the perioperative environment may have many undesired physiological effects that are associated with postoperative morbidity. There are different options for treating and/or preventing hypothermia within the adult perioperative environment, which include active and passive warming methods. This systematic review was undertaken to provide comprehensive evidence on the most effective strategies for prevention and management of inadvertent hypothermia in the perioperative environment.

Inadvertent hypothermia can have significant consequences in the perioperative setting. Knowing how to recognize and manage inadvertent hypothermia is an important aspect of perioperative nursing.A quantitative, descriptive study was conducted at an annual perioperative nursing conference to evaluate nurses' knowledge regarding the prevention of inadvertent perioperative hypothermia.Significant variations in responses regarding definitions of hypothermia and normothermia were noted. In addition, nurses identified a plethora of factors that prevent them from maintaining normothermia in their patients. These factors mandate a need for educational interventions and the adoption of practice guidelines in the clinical area. AORN J 89 (April 2009) 701–713. © AORN, Inc, 2009.

The present investigation was aimed at determining the spectrum of activity of the methanolic extract of Clitoria ternatea (CT) on the CNS. The CT was studied for its effect on cognitive behavior, anxiety, depression, stress and convulsions induced by pentylenetetrazol (PTZ) and maximum electroshock (MES). To explain these effects, the effect of CT was also studied on behavior mediated by dopamine (DA), noradrenaline, serotonin and acetylcholine. The extract decreased time required to occupy the central platform (transfer latency, TL) in the elevated plus maze (EPM) and increased discrimination index in the object recognition test, indicating nootropic activity. The extract was more active in the object recognition test than in the EPM. The extract increased occupancy in the open arm of EPM by 160% and in the lit box of the light/dark exploration test by 157%, indicating its anxiolytic activity. It decreased the duration of immobility in tail suspension test (suggesting its antidepressant activity), reduced stress-induced ulcers and reduced the convulsing action of PTZ and MES. The extract exhibited tendency to reduce the intensity of behavior mediated via serotonin and acetylcholine. The effect on DA-and noradrenaline-mediated behavior was not significant. In conclusion, the extract was found to possess nootropic, anxiolytic, antidepressant, anticonvulsant and antistress activity. Further studies are necessary to isolate the active principle responsible for the activities and to understand its mode of action. D

The present investigation was aimed at determining the spectrum of activity of the methanolic extract of Clitoria ternatea (CT) on the CNS. The CT was studied for its effect on cognitive behavior, anxiety, depression, stress and convulsions induced by pentylenetetrazol (PTZ) and maximum electroshock (MES). To explain these effects, the effect of CT was also studied on behavior mediated by dopamine (DA), noradrenaline, serotonin and acetylcholine. The extract decreased time required to occupy the central platform (transfer latency, TL) in the elevated plus maze (EPM) and increased discrimination index in the object recognition test, indicating nootropic activity. The extract was more active in the object recognition test than in the EPM. The extract increased occupancy in the open arm of EPM by 160% and in the lit box of the light/dark exploration test by 157%, indicating its anxiolytic activity. It decreased the duration of immobility in tail suspension test (suggesting its antidepressant activity), reduced stress-induced ulcers and reduced the convulsing action of PTZ and MES. The extract exhibited tendency to reduce the intensity of behavior mediated via serotonin and acetylcholine. The effect on DA-and noradrenaline-mediated behavior was not significant. In conclusion, the extract was found to possess nootropic, anxiolytic, antidepressant, anticonvulsant and antistress activity. Further studies are necessary to isolate the active principle responsible for the activities and to understand its mode of action. D

Background: Hypothermia is increasingly recognized as a major cause of neonatal morbidity and mortality in resource poor settings. High prevalence of hypothermia has been reported widely from warmer high mortality regions of Africa and South Asia. The World Health Organization recognizes newborn thermal care as a critical and essential component of essential newborn care; however, hypothermia continues to remain under-documented, under-recognized and under-managed.

An increasing body of evidence has revealed that interventions performed during resuscitation of extremely-low-gestational-age neonates (ELGANs) may have a direct influence on the immediate survival and also on long-term morbidity. It has been proposed that interventions in the delivery room and/or hypothermia could trigger changes constitutive of chronic lung disease. New approaches in the first minutes of life using more gentle parameters of intervention are being studied. Thus, titrating inspiratory fraction of oxygen, the use of non-invasive ventilation to reduce trauma to the lung, the use of polyethylene/polyurethane wrapping to avoid hypothermia and delaying cord clamping altogether constitute promising initiatives. The first minutes of life are a valuable window for intervention. However, whilst these practice changes make sense and there are emerging data to support them, further evidence including long-term follow up is needed to definitively change resuscitation procedures in ELGANs.

Hypothermia as a postoperative complication is very common. Risk factors for its development are various. From the specific characteristics of each patient (age, physical and nutritional state), including factors associated with surgery (type and length of surgery, nature of anaesthesia) to environmental factors (ambient temperature in the operating room, transfer to the operating room). The most significant complications associated with hypothermia encountered by medical staff are coagulation disorders, delayed wound healing, high risk of blood loss, increased risk of wound infection, impaired immunity and cardiac arrest. Furthermore, complications significantly increase treatment costs as well as morbidity, resulting in a negative outcome of patient treatment. Therefore, preventive measures are needed to stop the emergence of perioperative hypothermia, the administration of which the nurse is actively involved in. Simple precautionary measures which proved effective are preoperative patient assessment, minimizing skin exposure, patient education to raise awareness of temperature loss, providing adequate bedding during patient transfer, as well as passive and active warming. Those preventive measures can considerably reduce amount of heat loss and fasten patient recovery.
Key words: hypothermia, risk factors, complications, nursing interventions

The identification of hypothermia as the cause of death has always been somewhat problematic in forensic pathology because of unspecific, inconstant, or even negative macroscopic and microscopic findings. Though the simultaneous presence of frost erythema, Wischnewski spots, hemorrhages into the synovial membrane, bloody discoloration of synovial fluid of the knee, and basal vacuolization of the renal tubular epithelial cells has been indicated as strongly supportive of fatal hypothermia, their absence does not allow the diagnosis of hypothermia to be ruled out. Postmortem biochemical investigations are valuable in detecting adaptation responses to cold stress and metabolic changes that occur following cold exposure. However, ethanol intoxication prevents appearance of adaptation responses to cold, rendering the diagnosis less obvious. Immunohistochemistry, postmortem imaging, and molecular pathology have shown promising results, although at present, they do not provide pathognomonic signs of fatal hypothermia. The aim of this article is to present a review of the literature covering the significance of different postmortem investigations that are associated with hypothermia fatalities.

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The aim of this work is to present some practical, postmortem biochemistry applications to illustrate the usefulness of this discipline and reassert the importance of carrying out biochemical investigations as an integral part of the autopsy process. Five case reports are presented pertaining to diabetic ketoacidosis in an adult who was not known to suffer from diabetes and in presence of multiple psychotropic substances; fatal flecainide intoxication in a poor metabolizer also presenting an impaired renal function; diabetic ketoacidosis showing severe postmortem changes; primary aldosteronism presented with intracranial hemorrhage and hypothermia showing severe postmortem changes. The cases herein presented can be considered representative examples of the importance of postmortem biochemistry investigations, which may provide significant information useful in determining the cause of death in routine forensic casework or contribute to understanding the pathophysiological mechanisms involved in the death process.

Jahr 1952 war dessen temperatursenkende Wirkung in der Anästhesiologie wohlbekannt. Es wurde gezielt zur Erzeugung eines sog. künstlichen Winterschlafs ("hibernation artificielle") eingesetzt [24]. Andererseits gilt die Hyperthermie als Kardinalsymptom im Rahmen des sog. malignen neuroleptischen Syndroms. Dieses wurde als schwere und potenziell lebensgefährliche unerwünschte Arzneimittelwirkung von Delay et al. erstmals als "akinetisches hypertones Syndrom" im Jahr 1960 beschrieben [7, 18].

Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.

Appropriate thermal protection of the newborn prevents hypothermia and its associated burden of morbidity and mortality. Yet, current global birth practices tend to not adequately address this challenge. Here, we discuss the pathophysiology of hypothermia in the newborn, its prevention and therapeutic options with particular attention to resource-limited environments. Newborns are equipped with sophisticated mechanisms of body temperature regulation. Neonatal thermoregulation is a critical function for newborn survival, regulated in the hypothalamus and mediated by endocrine pathways. Hypothermia activates cellular metabolism through shivering and nonshivering thermogenesis. In newborns, optimal temperature ranges are narrow and thermoregulatory mechanisms easily overwhelmed, particularly in premature and low-birth weight infants. Hyperthermia most commonly is associated with dehydration and potentially sepsis. The lack of thermal protection promptly leads to hypothermia, which is associated with detrimental metabolic and other pathophysiological processes. Simple thermal protection strategies are feasible at community and institutional levels in resource-limited environments. Appropriate interventions include skin-to-skin care, breastfeeding and protective clothing or devices. Due to poor provider training and limited awareness of the problem, appropriate thermal care of the newborn is often neglected in many settings. Education and appropriate devices might foster improved hypothermia management through mothers, birth attendants and health care workers. Integration of relatively simple thermal protection interventions into existing mother and child health programs can effectively prevent newborn hypothermia even in resource-limited environments.