Following hospital discharge, premature infants remain susceptible to cold stress when exposed to lower environmental temperatures, primarily because of decreased subcutaneous tissue.4 Infants who are cold-stressed are not capable of responding by shivering but, rather, attempt to maintain body temperature by increasing their metabolism of brown fat, which results in heat production. However, this increases oxygen consumption and can lead to hypoglycemia. If this compensatory increase in metabolic rate is insufficient to overcome the low environmental temperature, then body temperature will fall. A normal body temperature, however, does not eliminate the possibility of cold stress, since body temperature may be maintained at considerable metabolic expense. The best way to avoid cold stress is to provide an adequate environmental temperature for the infant who is being evaluated in the emergency department. If the room temperature cannot be adjusted appropriately, a heat lamp should be available. Commercial heat lamps are available that have automatic timers and can be adjusted to provide varying amounts of heat. Such lamps should be standard equipment in emergency departments that treat infants and children.
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