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Thermal protection of the newborn
 Thermal protection of the newborn is the series of measures taken at birth and in the first days of life to ensure that the newborn does not become either cold or overheated and maintains a normal body temperature of 36.5-37.5 C.
The newborn cannot regulate its temperature as well as an adult and therefore needs to be protected from cold and heat. The smaller is the newborn, the greater the risk. Thermal stability improves gradually as the baby increases in weight.
The temperature inside the mother's womb is 38 C, leaving the warmth of the womb at birth; the wet newborn finds itself in a much colder environment and immediately starts losing heat in four different ways. Heat loss is mainly due to evaporation of amniotic fluid from the baby's body. But loss of body heat also occurs by conduction if the baby is placed naked on a cold surface (e.g. a table, weighing scale or cold mattress); by convection if the naked newborn is exposed to cooler surrounding air; and by radiation from the baby to cooler objects in the vicinity (e.g. a cold wall or a window) even if the baby is not actually touching them. Heat loss increases with air movement, and a baby risks getting cold even at a room temperature of 30 C if there is a draught.
A naked baby exposed to an environmental temperature of 23 C at birth, suffers the same heat loss as does a naked adult at 0 C.
 Most cooling of the newborn occurs during the first minutes after birth. In the first 10-20 minutes, the newborn who is not thermally protected may lose enough heat for the body temperature to fall by 2-4 C, with even greater falls in the following hours if proper care is not given. If heat loss is not prevented and is allowed to continue, the baby will develop hypothermia.
A hypothermic baby, especially if it is small or sick, is at increased risk of developing health problems and of dying. However, if heat loss is prevented, the newborn will stay warm and will have a much better chance of remaining healthy, or of surviving if it is already sick.
In trying to keep babies warm, it is important to make sure they do not become overheated. The mechanisms described above may act in reverse and cause hyperthermia. Although less common, hyperthermia is as dangerous as hypothermia.
Thermal protection of newborns is very important and not difficult. The basic principles are the same whether the baby is born at home or in an institution. As most cooling of the newborn occurs during the first minutes after birth, it is important to act quickly to prevent heat loss.
The "warm chain" is a set of interlinked procedures to be taken at birth and during the next few hours and days in order to minimize heat loss in all newborns. Failure to implement any one of these procedures will break the chain and put the newborn baby at risk of getting cold.
The 10 steps of the “Warm Chain”
• Warm delivery room 25-28 C
• Immediate drying
• Skin-to-skin contact
• Breast-feeding
• Bathing and weighing postponed
• Appropriate clothing/bedding
• Mother and baby together
• Warm transportation
• Warm resuscitation
• Training and awareness raising
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