Reduction of neonatal heat loss by an insulated head cover*

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When exposed to a cool environment, the newborn infant responds by nonshivering thermogenesis. The increased heat production is at the expense of body fuel and energy stores. A significant quantity of heat is lost from the head because of its large surface area and the high metabolic activity of the neonatal brain. The purpose of this study was to determine whether dry cranial heat loss could be significantly reduced by covering the head with highly insulated material, and to determine whether plastic lined hats decreased evaporative heat loss. A total of 46 fullterm and premature infants were studied. Hats insulated with material made of olefin and polyester reduced cranial dry heat loss by 73% and 63%. Plastic lined hats reduced evaporative heat loss by 68%. The insulated and lined hats proved to be a simple and safe method of effectively reducing dry and evaporative heat loss.

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    The addition of a neonate head covering may further support the return of thermal balance, although some discrepancies in research evidence raise the possibility that, for some neonates, this may not be sufficient. Researchers previously reported that woolen or insulated caps decreased and prevented heat loss (Lang et al., 2004; Rowe et al., 1983). Cotton caps were found to be as effective as wool or insulated head coverings only when used in combination with skin-to-skin placement (Lang et al., 2004).

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    The difference in temperature between the no hat group and the bonnet group was not statistically significant. Other studies have evaluated various materials, including Gamgee-lining, wool and cotton, and plastic, with varying but positive results.25–27 Hats prevent heat from escaping but do not prevent evaporative heat loss.

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    The head of the periviable infant should be covered by a hat. There is evidence to support the use of either a polyethylene plastic cap19,20 or woolen caps,21,22 but not the stockinette caps that are frequently used. Monitoring the infant's temperature while in the delivery room to guide further interventions and to prevent iatrogenic hyperthermia is useful.23

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*

Presented before the 14th Annual Meeting of the American Pediatric Surgical Association, Hilton Head Island, South Carolina, May 4–7, 1983.

1

From the Division of Pediatric Surgery University of Pittsburgh, School of Medicine, Children's Hospital of Pittsburgh.

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