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Keeping our body temperatures close to 98.5oF regardless of the temperature around us is one of the features that distinguishes humans as mammals. To do this, we have an elaborate system that either warms us up or cools us down as needed. Keeping warm when the environmental temperature is below 98o requires us to burn calories, and cooling off when the temperature is too hot requires us to sweat. Newborn babies – especially premies – cannot sweat, and may not have the fat stores to serve as a source of calories to stay warm. Anyone who has spent time outside in the cold knows the dangers of hypothermia. Every human will use up every single possible source of calories – fat then muscle – to maintain body temperature within that narrow range demanded by the brain. Other bodily functions will shut down to conserve calories and make them available to stay warm. Your preterm baby cannot grow and thrive if all his/her calories are being used to keep him/her warm. An incubator maintains the environment at the perfect temperature your baby needs – called the Neutral Thermal Environment -- not too warm and not too cold, but just right! ). The incubator also is a closed “micro-environment” for your baby that can be controlled to reproduce as much as possible the intrauterine experience – warm, wet, dark, quiet.

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There are two ways to choose the temperature inside the incubator for your baby: manual and servo mode. Manual mode works like the thermostat in your living room. You set the temperature you want the room to be, and the heater comes on when necessary to keep it that way. If you think it’s too warm, you either turn down the set point, take off some clothes, or open a window. If it’s too cold, you turn it up, or put on a sweater/blanket. Some people in the room may be comfortable while others may not, because every person has a different metabolism. In manual mode on the incubator, the same things can happen. The nurse “picks” a temperature that s/he thinks is right. If it’s too hot, your baby will overheat, because s/he cannot sweat to cool down. You can tell this by an increased heart rate and/or breathing rate on the monitors. Your nurse will turn down the set point, maybe open the doors and/or take off a blanket or two. Servo control lets your baby set the proper temperature: a small probe is placed on your baby’s abdomen or back that measures his/her skin temperature. That measurement “feeds back” to the incubator which compares it to the target temperature set in the machine (usually 36.3 – 36.5oC). When the measured skin temperature is too low, the heater comes on, and stays on until the skin temperature reaches the target. This mode allows your baby to set the perfect temperature – not too hot and not too cold. When s/he is sleeping, the machine will heat up more because your baby isn’t moving around as much. When s/he is awake, the temperature inside the incubator will drop a bit so your baby doesn’t overheat. While this mode is better for the baby, it is more difficult to manage and nurses/parents don’t like it as much. Talk to your neonatologist if you have questions about your baby’s neutral thermal environment.

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Humans have a coating on their skin called keratin that helps stabilize our body temperatures and keeps too much water from evaporating through the skin’s pores. This prevents dehydration (unless we’re exercising and/or sweating profusely, which is a different mechanism of evaporation). Preterm babies’ skin doesn’t have this keratin layer yet, so they can very quickly get cold and/or dehydrated. Even in areas of the country where it’s very humid outside, the air conditioned air inside the NICU is relatively dry – (you may notice your hands and/or lips seem really dry after being in the hospital for a while). The incubator is a closed “micro-environment” for your baby that can be controlled to reproduce as much as possible the intrauterine experience – warm, wet, dark, quiet. By introducing humidity, your baby will not experience as much dehydration through his/her skin, which will help him/her to adapt to being outside the womb, and to thrive and grow. Your baby’s skin will gradually become keratinized, and the humidity will be decreased.

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Maintaining body temperature in the “normal” range is a biologic imperative for mammals – and humans are mammals. We will use up every single source of calories, and shut down every other body function including breathing, to keep warm. And when that no longer works and the body temperature drops, that’s called hypothermia – and then we die. We burn calories to keep warm, but there’s no way to know exactly how many calories are being burned at any given time to maintain a normal body temperature. If your baby is cold, then things have already progressed too far, and your baby no longer has enough calories to keep his/her temperature normal. This is DANGEROUS for your baby. And if your baby is hot, we can know that because s/he cannot cool him/herself down by sweating like older babies and others can do. But, if your baby’s temperature is “normal,” we don’t know if your baby is experiencing a neutral thermal environment, or if s/he is burning excess calories to keep his/her body temperature up. Burning excess calories is not desirable, as his/her growth and development will not be ideal, and s/he may exhaust his/her supply of calories and then get cold. An incubator will maintain a neutral thermal environment and keep your baby from burning extra calories just to stay warm.

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If your baby’s incubator is set on “servo control” (see above), then it’s important that the skin probe is open and uncovered to function properly. If the probe is covered by clothes or blankets, then it thinks your baby is warmer than s/he really is, and the air inside the incubator will not be warm enough to provide a neutral thermal environment.

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