Radiant warmers versus incubators for regulating body temperature in newborn infants

Flenady, V. and Woodgate, P.G. (2003) Radiant warmers versus incubators for regulating body temperature in newborn infants. Cochrane Library Systematic Reviews, 3 4, Article No.: CD000435: 1-25. doi:10.1002/14651858.CD000435

Author Flenady, V.
Woodgate, P.G.
Title Radiant warmers versus incubators for regulating body temperature in newborn infants
Journal name Cochrane Library Systematic Reviews   Check publisher's open access policy
ISSN 1464-780X
Publication date 2003
Sub-type Article (original research)
DOI 10.1002/14651858.CD000435
Volume 3
Issue 4, Article No.: CD000435
Start page 1
End page 25
Total pages 25
Place of publication Vista, California
Publisher John Wiley and Sons, Ltd.
Collection year 2003
Language eng
Subject C1
321019 Paediatrics
730204 Child health
Formatted abstract
The provision of a thermoneutral environment is an essential component of the immediate and longer term care of newborn infants. A variety of methods are currently employed including incubators and open-care systems, with or without modifications such as heat shields and plastic wrap. The system used must allow ready access to the infant but should also minimise alterations in the immediate environment.


To assess the effects of radiant warmers versus incubators on neonatal fluid and electrolyte balance, morbidity and mortality.

Search strategy

The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of electronic databases: Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2005), MEDLINE (1966 -2005), and CINAHL (1982-2005), previous reviews including cross references, abstracts, conferences, symposia proceedings, expert informants and journal hand searching mainly in the English language.

Selection criteria

Randomised or quasi-randomised trials in which radiant warmers were compared to incubators in a neonatal population.

Data collection and analysis

Independent data extraction and quality assessment of included trials was conducted by the authors. Data were analysed using relative risk (RR) and weighted mean difference (WMD). Results are presented with 95% confidence intervals. Meta-analysis was undertaken using a fixed effect model.

Main results

Eight studies are included in this review; six employed a crossover design. In the overall comparison of radiant warmers vs incubators, radiant warmers caused a statistically significant increase in insensible water loss (IWL) [WMD 0.94g/Kg/day (95% CI 0.47, 1.41)] and a trend towards increased oxygen consumption which was not statistically significant [WMD 0.27mL/kg/min (95% CI -0.09, 0.63)]. Due to small numbers, effects on important clinical outcomes could not be adequately assessed. A comparison of radiant warmers with heat shields vs incubators without heat shields showed a trend for increased IWL in the radiant warmer group, which was not statistically significant. No difference was shown in oxygen consumption.

Authors' conclusions

Radiant warmers result in increased IWL compared to incubators. This needs to be taken into account when calculating daily fluid requirements. The results of this review do not provide sufficient evidence concerning effects on important outcomes to guide clinical practice. Further randomised controlled trials are required to assess the effects of radiant warmers versus incubators in neonatal care on important short and long term outcomes, with particular attention to extremely low birthweight infants in the early neonatal period.

Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2004 Higher Education Research Data Collection
School of Medicine Publications
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Created: Tue, 14 Aug 2007, 18:47:03 EST