Recommended Ambient Temperature for Delivery Room and SNCU
The delivery room temperature should be maintained at ≥23°C (preferably 23-25°C or 74°F) for preterm infants <34 weeks' gestation to prevent hypothermia on NICU admission. 1
Delivery Room Temperature Settings
For Preterm Infants (<34 weeks' gestation)
- Maintain ambient temperature at ≥23°C (73.4°F), with optimal range of 23-25°C (73.4-77°F) 1
- Some centers successfully use 74°F (23.3°C) as a standard protocol 2, 3
- Evidence shows that delivery room temperature <25°C is independently associated with increased risk of hypothermia (adjusted OR 1.44) 1
For Term and Late Preterm Infants (≥34 weeks' gestation)
- Room temperature of ≥23°C is recommended compared to 20°C to maintain normal temperature 1, 4
- This represents a weak recommendation with very low-certainty evidence 1
Evidence Supporting Temperature Recommendations
The 2023 International Consensus guidelines demonstrate that:
- Higher delivery room temperatures (24-26°C vs 20-23°C) result in increased body temperature on admission (mean difference 0.5°C higher) 1
- Temperatures of 25-28°C versus 20°C reduce hypothermia incidence (RR 0.69) 1
- A randomized trial comparing 23°C versus 20°C operating room temperature showed significantly reduced neonatal hypothermia (35% vs 50%, p<0.001) and moderate-to-severe hypothermia (5% vs 19%, p<0.001) 3
SNCU/NICU Temperature Considerations
While the evidence focuses primarily on delivery room temperature, the following principles apply:
Target Infant Temperature
- Normal temperature range: 36.5-37.5°C per WHO criteria 5, 3
- Hypothermia is defined as <36.5°C (some protocols use <36.0°C) 1, 6
- Hyperthermia is defined as >37.5-38.0°C and should be avoided 1, 6, 1
Combination Interventions for Preterm Infants
For infants <32-34 weeks' gestation, use a bundle approach including: 1, 6, 7
- Environmental temperature 23-25°C 1, 6, 7
- Plastic wrap without drying 1
- Head cap 1, 6
- Thermal mattress (when hypothermia is identified as a problem) 1
- Radiant warmer with servo control 1, 6
- Warm blankets 1, 6
Critical Caveats and Monitoring
Risk of Hyperthermia
- Thermal mattress use increases risk of hyperthermia (RR 2.77-3.44) 1
- Number needed to harm for hyperthermia with thermal mattress is 8-9 infants 1
- Very high ambient temperatures (34°C vs 28°C) significantly increase hyperthermia risk (RR 11.48) 1
- Temperature must be carefully monitored to prevent hyperthermia 4
Quality Improvement Data
- A single-center study using 74°F delivery room temperature with thermal mattress achieved 91% normothermia in extremely low birth weight infants, with hypothermia <2.5% and hyperthermia 6.5% 2
- For moderate and late preterm infants (32-36 weeks), expanding thermoregulation protocols reduced hypothermia from 27% to 7.8%, but increased mild hyperthermia from 1.4% to 6.2% 8
Implementation Considerations
- Dedicated delivery rooms/operating rooms for preterm deliveries ≤32 weeks should have temperature set at 74°F (23.3°C) continuously 2
- Hospital engineering staff should maintain these settings 24/7 2
- Compliance with thermal mattress removal protocols is essential to prevent hyperthermia 8
Evidence Strength
The recommendations are based on:
- Weak recommendations with very low to low-certainty evidence for room temperature settings 1, 4
- High-certainty evidence for plastic wrap/bag use improving survival in preterm infants 1
- Moderate-certainty evidence for reduced hypothermia with plastic wrap 1
- Observational studies showing consistent benefit from combination interventions 6