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the top o f the neutral zone, produeed a significant rise in insensible water loss, from 1.90 + O. 76 to
3.08 ++-1.19 m l / k g / h o u r (mean + SD), a corresponding rise in evaporative heat loss, and a fall in
nonevaporative heat loss. A decrease of l to 2~
in an increase in oxygen consumption from 5.82 +-_ 0.92 to Z45 ++_1.50 ml/kg/minute, and an increase
in total heat loss, but no change in insensible water loss and evaporative heat loss. The increased total
heat loss was judged to be due entirely to a greater nonevaporative heat loss, both by convection and by
. radiation. The data confirm that ambient temperature is an important determinant o f the magnitude and
the partition o f heat loss in low-birth-weight infants.
Volume 96
Number 3, part 1
NEUTRAL
THERMAL
58-
ZONE
I kg (0.75- 1.25)
37563534-
323130---
38-
AND METHODS
-4
1,5 kg ([.25-1.75)
37-
453
56-
AMBIENT
TEMPERATURE
(~
3534-
32-
30- - -
38
37-
.25)
36555455
32.
T4 0
3130
,;
AGE
,;
2'0 2;
~'o
(Days)
Fig. 1. Theoretical neutral thermal zones for different birthweight ranges, modified from Hey.'~The three lines represent the
boundaries and the midpoint of the neutral zone. For each
subject, the ambient temperatures for the four study periods were
taken from these charts. The points labeled T,, T.., T:, and T~ are
shown here as they would be chosen for a 13-day-old infant in
each weight group. T,, T~, and T:~ are intended to approximate
the top, midpoint, and bottom of the neutral zone, respectively,
and T~ a point I~ below the zone.
4 54
Bell et al.
SMULTI -CHANNEL ~
SCALE METER. ITELETHERMOMETERI
( ; vocoN
O ' TEMP. PROBES
PROBE
METER L
o2
ANALYZER
with
Ill
L
Hygrorneter- ~ L.h-I [
HEATIE~
AMBIENT~
TEMP. ~l "'~ L . ~
INCUBATOR
--~VALVE
= Q (FI%- Fs%).
RESULTS
For the purpose of analyzing the results, the neutral
temperature for each infant was defined as the ambient
temperature at which the mean oxygen consumption was
Volume 96
Number 3, part 1
45 5
Table I
Birth weight
range and
individual
weights (kg)
< 1.25
(1.15, 1.21,
121, 1.24)
Gestational
age
range
(wk)
28-29
Thermal
environment
Supraneutral
Neutral
31-34
(1.30, 1.40,
1.46, 1.56)
Subneutral
Supraneutral
Neutral
1.75-2.25
(1.77, 1.98,
2.16, 2.20)
32-35
Subneutral
Supraneutral
Neutral
1.25-1.75
Subneutral
Tomb
'/room
Relative
humidity
36.6*
0.1
35.1
9+0.5
33.8*
36.0*
0.1
34.3
32.8*
0.2
35.1"
+ 0.1
33.2
31.1"
-+0.4
24.9
_+0.5
24.8
_+0.4
24.4
24.4
_+0.6
24.9
25.2
_+0.7
24.7
-+0.5
25.0
_+0,8
24.6
1.0
38.5
1.2
38.8
1.3
39.2
___1.5
40.1
38.8
39.6
37.4
_+9.7
36.9
10.7
36.8
_+9.6
rwall
r~ba
Thee,
T~
31.9
---0.4
31.6
-0.1
30.5
---0.8
32.1"
--+0.5
~31.4
-+0.5
30.7"
30.8
29.6
28.2*
36.3
-+0.4
36.4
0.3
36.0
_+0.5
36.3
36.2
36.2
36~2
36.3
35.6*
-+0.5
34.5
0.5
34.6
-+0.7
33.1"
-+0.6
35.0
34.4
33.0*
35.2
___0.7
35.0
33.0*
___0.8
36.1
0.4
36.2
0.4
35.7*
36.2*
36:0
35.9
36.1
36.2
35.4*
I Heart
rate
r,.eet
36.7
0.3
36.8
0.3
36.3*
36.6
36.6
36.3
37.0
_+0.1
37.0
-+0.2
36.8*
154
148
146
-+15
136
+7
139
140
-+9
152
-+7
148
-+li
146
+12
Respiratory
rate
54
+12
45
-+6
46
+I0
39
-+3
38
+4
36
51
45
54
456
Bell et al
Table li
Birth weight
range (kg)
Thermal
environment
< 1.25
Supraneutral
(n = 4)
Neutral
Subneutral
1.25-1.75
Supraneutral
(n = 4)
Neutral
Subneutral
1.75-2.25
Supraneutral
(n = 4)
Neutral
Subneutral
All subjects
Supraneutral
(n = 12)
Neutral
Subneutral
Mean
oxygen
.consump tion
(ml/kg/
rain STPD)
6.07
__. 1.26 "
5.31
_+ 0.52
6.69
1.34
5.95
+_ i.63
5.81
_+ 1.39
7.29
'
_+ 1.54
6.40
_+ 0.52
6.32
0.47
8.38*
+ 1.45
6.14
1.13
5.82
0.92
7.45*
_ 1.50
Insensible
water loss
(gm / k g /
hr)
Heat
Production
(kcal/
kg/hr)
Heat
storage
(kcal/
kg/hr)
Total
heat loss
(kcal/
kg/hr)
Evaporative
heat loss
(kcal/
kg/hr)
Nonevaporative
heat loss
(kcal/
kg/hr)
4.08
+ 1.20
2.36
0.98
2.14
1.20
3:18"
_+ 0.82
1.99
0.42
2.02
_+ 0.45
1.98
+ 0.30
1.36
_+ 0.54
1.48
+_ 0.31
3.08*
_+ 1.19
1.90
_+ 0.76
1.88
0.75
1.76
+ 0.36
1.54
+ 0.15
1.94
- 0.39
1.72
0.47
1.68
_ 0.41
2.11
0.45
1.85
0.15
1.83
+ 0.14
2.43
0.42
1.78
_+ 0.33
1.69
___0.27
2.16"
0.44
0.22
-- 0.10
0.03
i?.10
--0.11
-4- 0.07
0.34*
_ 0.16
0.04
-- 0.16
-0.17
- 0.10
0.15
+ 0.08
0.02
___0.08
-0.08
0.12
0.24*
_-!-0.]3
0.03
___0.11
--0.12"
0.10
1.54
_ 0.45
1.51
_+ 0.25
2.05*
-+ 0.39
1.38
4- 0.34
1.64
___0.37
2.28
_+ 0.50
1.70
+ 0.20
1.81
+ 0.13
2.51"
0.44
1.54
0.34
1.66
0.27
2.28*
0.45
2.37
0.70
1.37
+ 0.57
1.24
0.70
1.84'
___0.48
1.15
0.24
1.17
_+0.26
1.15
0.17
0.79
- 0.32
0.86
0.18
1.79"
_-,- 0.69
1.10
0.44
1.09
0.44
-0.83
0.36
0.14
~ 0.76
0.81"
_+ 0.86
--0.46*
-- 0.57
0;49
0.43
1.11
___0.65
0.55
0.12
1.02
_+ 0.25
1.65
0.41
-0.25*
0.71
0.56
___0.60
1.19"
0.71
tubing, which would affect the scale reading. I n particular, the h o s e from the h o o d m u s t be secured carefully at
the outlet port from the incubator. A n o t h e r p r o b l e m
relates to the fact that nonevaporatiVe heat loss is calculated from total a n d evaporative heat loss, a n d not
m e a s u r e d directly. Since heat p r o d u c t i o n a n d heat loss in
this study were derived from the m e a n o f several m i n i m a l
ox~cgen c o n s u m p t i o n readings, they m a y Underestimate
the total heat p r o d u c t i o n a n d heat loss occuring d u r i n g a n
entire study period, by w h a t e v e r degree "v'O2 varied a b o v e
the m e a n m i n i m a l value during the period. E v a p o r a t i v e
heat loss, on the other h a n d , is calculated from total
insensible water loss d u r i n g each period; if total heat toss
is underestimated, n o n e v a p o r a t i v e heat loss is also u n d e r estimated. T h e m a g n i t u d e of this error can be estimated
using the data of Brooke et al. 2~A s s u m i n g that o u r oxygen
c o n s u m p t i o n m e a s u r e m e n t s reflect resting plus postprandial metabolism, the average i n c r e m e n t for activity would
be a n additional 36%. Thus, h a d our infants' activity
patterns b e e n similar to those in infants studied by Brooke
et al, a n d if we h a d included periods of activity in our
m e a s u r e m e n t of oxygen c o n s u m p t i o n , the m e a n n o n e v a p -
Volume 96
Number 3, part 1
orative heat loss zor all subjects (see the bottom of the last
column in Table II) would have been increased to + 0.39,
1.16, and 1.96 kcal/kg/hour, at the supraneutral, neutral,
and subneutral temperatures, respectively.
There are two other likely sources of error based on the
assumptions used in the heat balance calculations. (1)
The figure used for the caloric equivalent of oxygen
consumed, 4.83 kcal pe r liter, is a reasonable average
value. However, this value depends on the respiratory
quotient, which has bee n shown to vary with environmental temperature. 27 Thus , our assumed caloric value for
oxygen may have led to an underestimation of heat
production at the warmer temperature and an overestimation in the cooler environment. (2) Our calculation of
insensible water loss from weight loss assumes the weight
difference between carbon dioxide produced and oxygen
consumed to be negligible. Although the resulting error is
usually considered to be acceptably small, it becomes
more important in this study, because the magnitude o f
the error may depend on the environmental temperature.
If the RQ is lower at cooler temperatures, '-'7 then the
CO2-O2 weight difference will also be smaller, as will the
error in insensible water loss Calculation. At the warmer
environmental temperature the error will be greater,
causing an overestimation of insensible water loss and
consequently an underestimation of nonevaporative heat
loss. All of the errors discussed here are likely to have
caused an underestimation of nonevap0rative heat loss at
all temperatures , but especially in the supraneutral thermal environment. The latter two sources of error would
have been preventable had we been able to measure
carbon dioxide production and, thereby, respiratory
quotient.
The major advantage of this method is that it allows
noninvasive assessment of heat balance, at the cribside if
necessary, in an environment which is virtually identical
to that employed in the day-to-day care of the infant.
Except for the initial arrangement of the apparatus and
taping of temperature p~'obes to the skin, the infants were
not disturbed and nearly all slept throughout each study
period.
Our mean minimal oxygen consumption values at
neutral ambient temperatures, 5.31 to 6.32 ml/kg/minute,
are very similar to those reported previously by other
authors for premature infants 10 to 15 days of
age?- ~ 7.8. ~8. _~ Our results are consistent with the data of
Mesty~in et al, 8 who showed that minimal oxygen consumption expressed per kg of body weight correlates with
maturity in the first weeks of life; i.e., the smallest infants
have lower rates of Oxygen consumption than larger
prematures. As with the infants studied by Okken et al, 2~
we found the evaporative heat loss to contribute a larger
4 57
T.bd-T~,~b
T~bd-Tw~H
Neutral
temperature
2.1 1.0
5.5 1.0
Subneutral
temperature
3.3 _+ 1.1
6.1 _+ 1.1
< 0.001
< 0.001
458
B e l l et al.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
REFERENCES
1.
2.
3.
4.
5.
Hardy JD. and Soderstrom GF: Heat loss from the nude
body and peripheral blood flow at temperatures of 22~ to
35~ J Nutr 16:493. 1938.
BrOck K: Temperature regulation in the newborn infant.
Biol Neonate 3:65. 1961.
Hill JR. and Rahimtulla KA: Heat balance and the metabolic rate of new-born babies in relation to environmental
temperature: and the effect of age an d of weight on basal
metabolic rate. J Physiol Lond/ 180:239. 1965.
Scopes JW. and Ahmed I: Range of critical temperatures in.
sick and premature newborn babies. Arch Dis Child 41:417.
1966.
Hey EN: The relation between environmental temperature
and oxygen consumption in the new-born baby, J Physiol
(Lond) 200:589. 1969.
21.
22.
23.
24.
BrOck K, Parmelee AH Jr, and BrOck M: Neutral temperature range and range of "thermal comfort" in premature
infants, Biol Neonate 4:32, 1962.
Adams FH, Fujiwara T, Spears R, and Hodgman J:
Temperature regulation in premature infants, Pediatrics
33:487, 1964.
Mestyfin J, Fekete M, Bata G, and J/trai I: The basal
metabolic rate of premature infai3ts, Biol Neonate 7:11,
1964.
Hey EN, and Katz G: The optimum thermal environment
for naked babies~ Arch Dis Child 45:328, 1970.
Hey E: The care of babies in incubators, in Gairdner D, and
Hull D, editors: Recent advances in paediatrics, ed 4,
London, 1971, J & A Churchill, pp 171-2151
Silverman WA, Fertig JW, and Berger AP: The influence of
the therma[ environment upon the survival of newly born
premature infants, Pediatrics 22:876, 1958.
Glass L, Silverman WA, and Sinclair JC: Effect of the
thermal environment on cold resistance and growth of small
infants after the first week of life, Pediatrics 41:1033,
1968.
Hey EN, and Katz G: Evaporative water loss in the
new-born baby, J Physiol (Lond) 200:605, 1969.
Ryser G, and J6quier E: Study by direct calorimetry of
thermal balance on the first day of life, Eur J Clin Invest
2:176, 1972.
Kajtfir P, J6quier E, and Prod'hom LS: Heat losses in
newborn infants of different body size measured by direct
calorimetry in a thermoneutral and a cold em?irdnment,
Biol Neonate 30:55, 1976
Bell EF, Neidich GA, Cashore W J, and Oh W: Combined
effect of radiant warmer and phototherapy on insensible
water loss in low-birth-weight infants, J PEDIATR 94:810,
1979.
Silverman WA, and Agate FJ Jr: Variation in cold
resistance among small newborn infants, Biol Neonate
6:113, 1964.
Lees MH, Bristow JD, Way C, and Brown M: Cardiac
output by Fick principle in infants and young children, Am
J Dis Child 114:144, 1967.
Kappagoda CT, and Linden R J: A critical assessment of an
open circuit technique for measuring oxygen consumption,
Cardiovasc Res 6:589, 1972.
Lister G, Hoffman JIE, and Rudolph AM: Oxygen uptake
in infants and children: A simple method for measurement,
Pediatrics 53:656, 1974.
Fixler DE, Carrell T, Browne R, Willis K, and Miller WW:
Oxygen consumption in infants and children during cardiac
catheterization under different sedation regimens, Circulation 50:788, 1974.
Darnall RA Jr, and Afiagno RL: Minimal oxygen consumption in infants cared for under overhead radiant warmers
compared with conventional incubators, J PEmATR 93:283,
1978.
Sinclair JC: Metabolic rate and temperature control in the
newborn baby, in Saling E, and Schtflte FJ, editors: Perinatale Medizin, Band II, Stuttgart, 1972, Georg Thieme
Verlag, pp 200-205.
Swye r PR: Heat loss after birth, in Sinclair JC, editor:
Temperature regulation and energy metabolism in the
newborn, New York, !978, Grune & Stratton, Inc., pp
91-128.
Volume 96
Number 3, yart 1
25.
26
459
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