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Fulltext Thermoregulation and golden hour practices in extremely preterm infants: an international survey

Jani P, Mishra U, Buchmayer J, Walker K, Gözen D, Maheshwari R, et al.

Pediatr Res, 2023 May;93(6):1701-1709.
PMID: 36075989 DOI: 10.1038/s41390-022-02297-0

BACKGROUND: Are thermoregulation and golden hour practices in extremely preterm (EP) infants comparable across the world? This study aims to describe these practices for EP infants based on the neonatal intensive care unit's (NICUs) geographic region, country's income status and the lowest gestational age (GA) of infants resuscitated.
METHODS: The Director of each NICU was requested to complete the e-questionnaire between February 2019 and August 2021.
RESULTS: We received 848 responses, from all geographic regions and resource settings. Variations in most thermoregulation and golden hour practices were observed. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission, and having local protocols were the most consistent practices (>75%). The odds for the following practices differed in NICUs resuscitating infants from 22 to 23 weeks GA compared to those resuscitating from 24 to 25 weeks: respiratory support during resuscitation and transport, use of polyethylene plastic wrap and servo-control mode, commencing ambient humidity >80% and presence of local protocols.
CONCLUSION: Evidence-based practices on thermoregulation and golden hour stabilisation differed based on the unit's region, country's income status and the lowest GA of infants resuscitated. Future efforts should address reducing variation in practice and aligning practices with international guidelines.
IMPACT: A wide variation in thermoregulation and golden hour practices exists depending on the income status, geographic region and lowest gestation age of infants resuscitated. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission and having local protocols were the most consistent practices. This study provides a comprehensive description of thermoregulation and golden hour practices to allow a global comparison in the delivery of best evidence-based practice. The findings of this survey highlight a need for reducing variation in practice and aligning practices with international guidelines for a comparable health care delivery.

Matched MeSH terms: Body Temperature Regulation
Comparison of thermoregulatory responses to heat between Malaysian and Japanese males during leg immersion

Wijayanto T, Wakabayashi H, Lee JY, Hashiguchi N, Saat M, Tochihara Y

Int J Biometeorol, 2011 Jul;55(4):491-500.
PMID: 20824480 DOI: 10.1007/s00484-010-0358-5

The objective of this study was to investigate thermoregulatory responses to heat in tropical (Malaysian) and temperate (Japanese) natives, during 60 min of passive heating. Ten Japanese (mean ages: 20.8 ± 0.9 years) and ten Malaysian males (mean ages: 22.3 ± 1.6 years) with matched morphological characteristics and physical fitness participated in this study. Passive heating was induced through leg immersion in hot water (42°C) for 60 min under conditions of 28°C air temperature and 50% RH. Local sweat rate on the forehead and thigh were significantly lower in Malaysians during leg immersion, but no significant differences in total sweat rate were observed between Malaysians (86.3 ± 11.8 g m(-2) h(-1)) and Japanese (83.2 ± 6.4 g m(-2) h(-1)) after leg immersion. In addition, Malaysians displayed a smaller rise in rectal temperature (0.3 ± 0.1°C) than Japanese (0.7 ± 0.1°C) during leg immersion, with a greater increase in hand skin temperature. Skin blood flow was significantly lower on the forehead and forearm in Malaysians during leg immersion. No significant different in mean skin temperature during leg immersion was observed between the two groups. These findings indicated that regional differences in body sweating distribution might exist between Malaysians and Japanese during heat exposure, with more uniform distribution of local sweat rate over the whole body among tropical Malaysians. Altogether, Malaysians appear to display enhanced efficiency of thermal sweating and thermoregulatory responses in dissipating heat loss during heat loading. Thermoregulatory differences between tropical and temperate natives in this study can be interpreted as a result of heat adaptations to physiological function.

Matched MeSH terms: Body Temperature Regulation/physiology*
Effects of exercise in the heat on thermoregulation of Japanese and Malaysian males

Saat M, Tochihara Y, Hashiguchi N, Sirisinghe RG, Fujita M, Chou CM

J Physiol Anthropol Appl Human Sci, 2005 Jul;24(4):267-75.
PMID: 16079566

The effect of low-intensity exercise in the heat on thermoregulation and certain biochemical changes in temperate and tropical subjects under poorly and well-hydrated states was examined. Two VO2max matched groups of subjects consisting of 8 Japanese (JS) and 8 Malaysians (MS) participated in this study under two conditions: poorly-hydrated (no water was given) and well-hydrated (3 mL x Kg(-1) body weight of water was provided at onset of exercise, and the 15th, 35th and 55th min of exercise). The experimental room in both countries was adjusted to a constant level (Ta: 31.6+/-0.03 degrees C, rh: 72.3+/-0.13%). Subjects spent an initial 10 min rest, 60 min of cycling at 40% VO2max and then 40 min recovery in the experimental room. Rectal temperatures (Tre) skin temperatures (Tsk), heart rate (HR), heat-activated sweat glands density (HASG), local sweat rate (M sw-back) and percent dehydration were recorded during the test. Blood samples were analysed for plasma glucose and lactate levels.The extent of dehydration was significantly higher in the combined groups of JS (1.43+/-0.08%) compared to MS (1.15+/-0.05%). During exercise M sw-back was significantly higher in JS compared to MS in the well-hydrated condition. The HASG was significantly more in JS compared to MS at rest and recovery. Tre was higher in MS during the test. Tsk was significantly higher starting at the 5th min of exercise until the end of the recovery period in MS compared to JS. In conclusion, tropical natives have lower M sw-back associated with higher Tsk and Tre during the rest, exercise and recovery periods. However, temperate natives have higher M sw-back and lower Tsk and Tre during experiments in a hot environment. This phenomenon occurs in both poorly-hydrated and well-hydrated states with low intensity exercise. The differences in M sw-back, Tsk and Tre are probably due to a setting of the core temperature at a higher level and enhancement of dry heat loss, which occurred during passive heat exposure.

Matched MeSH terms: Body Temperature Regulation/physiology*
Thermal sensations and comfort investigations in transient conditions in tropical office

Dahlan ND, Gital YY

Appl Ergon, 2016 May;54:169-76.
PMID: 26851476 DOI: 10.1016/j.apergo.2015.12.008

The study was done to identify affective and sensory responses observed as a result of hysteresis effects in transient thermal conditions consisting of warm-neutral and neutral - warm performed in a quasi-experiment setting. Air-conditioned building interiors in hot-humid areas have resulted in thermal discomfort and health risks for people moving into and out of buildings. Reports have shown that the instantaneous change in air temperature can cause abrupt thermoregulation responses. Thermal sensation vote (TSV) and thermal comfort vote (TCV) assessments as a consequence of moving through spaces with distinct thermal conditions were conducted in an existing single-story office in a hot-humid microclimate, maintained at an air temperature 24 °C (± 0.5), relative humidity 51% (± 7), air velocity 0.5 m/s (± 0.5), and mean radiant temperature (MRT) 26.6 °C (± 1.2). The measured office is connected to a veranda that showed the following semi-outdoor temperatures: air temperature 35 °C (± 2.1), relative humidity 43% (± 7), air velocity 0.4 m/s (± 0.4), and MRT 36.4 °C (± 2.9). Subjective assessments from 36 college-aged participants consisting of thermal sensations, preferences and comfort votes were correlated against a steady state predicted mean vote (PMV) model. Local skin temperatures on the forehead and dorsal left hand were included to observe physiological responses due to thermal transition. TSV for veranda-office transition showed that no significant means difference with TSV office-veranda transition were found. However, TCV collected from warm-neutral (-0.24, ± 1.2) and neutral-warm (-0.72, ± 1.3) conditions revealed statistically significant mean differences (p < 0.05). Sensory and affective responses as a consequence of thermal transition after travel from warm-neutral-warm conditions did not replicate the hysteresis effects of brief, slightly cool, thermal sensations found in previous laboratory experiments. These findings also indicate that PMV is an acceptable alternative to predict thermal sensation immediately after a down-step thermal transition (≤ 1 min exposure duration) for people living in a hot-humid climate country.

Matched MeSH terms: Body Temperature Regulation/physiology
Fulltext A comparison of hydration effect on body fluid and temperature regulation between Malaysian and Japanese males exercising at mild dehydration in humid heat

Wakabayashi H, Wijayanto T, Lee JY, Hashiguchi N, Saat M, Tochihara Y

J Physiol Anthropol, 2014 Feb 04;33(1):5.
PMID: 24490869 DOI: 10.1186/1880-6805-33-5

BACKGROUND: This study investigated the effect of hydration differences on body fluid and temperature regulation between tropical and temperate indigenes exercising in the heat.
METHODS: Ten Japanese and ten Malaysian males with matched physical characteristics (height, body weight, and peak oxygen consumption) participated in this study. Participants performed exercise for 60 min at 55% peak oxygen uptake followed by a 30-min recovery at 32°C and 70% relative air humidity with hydration (4 times each, 3 mL per kg body weight, 37°C) or without hydration. Rectal temperature, skin temperature, heart rate, skin blood flow, and blood pressure were measured continuously. The percentage of body weight loss and total sweat loss were calculated from body weight measurements. The percentage change in plasma volume was estimated from hemoglobin concentration and hematocrit.
RESULTS: Malaysian participants had a significantly lower rectal temperature, a smaller reduction in plasma volume, and a lower heart rate in the hydrated condition than in the non-hydrated condition at the end of exercise (P <0.05), whereas Japanese participants showed no difference between the two hydration conditions. Hydration induced a greater total sweat loss in both groups (P <0.05), and the percentage of body weight loss in hydrated Malaysians was significantly less than in hydrated Japanese (P <0.05). A significant interaction between groups and hydration conditions was observed for the percentage of mean cutaneous vascular conductance during exercise relative to baseline (P <0.05).
CONCLUSIONS: The smaller reduction in plasma volume and percentage body weight loss in hydrated Malaysians indicated an advantage in body fluid regulation. This may enable Malaysians to reserve more blood for circulation and heat dissipation and thereby maintain lower rectal temperatures in a hydrated condition.

Matched MeSH terms: Body Temperature Regulation/physiology*
Comparison of heat dissipation response between Malaysian and Japanese males during exercise in humid heat stress

Wakabayashi H, Wijayanto T, Lee JY, Hashiguchi N, Saat M, Tochihara Y

Int J Biometeorol, 2011 Jul;55(4):509-17.
PMID: 20949285 DOI: 10.1007/s00484-010-0374-5

This study investigated the differences in heat dissipation response to intense heat stress during exercise in hot and humid environments between tropical and temperate indigenes with matched physical characteristics. Ten Japanese (JP) and ten Malaysian (MY) males participated in this study. Subjects performed exercise for 60 min at 55% peak oxygen uptake in 32°C air with 70% relative humidity, followed by 30 min recovery. The increase in rectal temperature (T(re)) was smaller in MY during exercise compared to JP. The local sweat rate and total body mass loss were similar in both groups. Both skin blood flow and mean skin temperature was lower in MY compared to JP. A significantly greater increase in hand skin temperature was observed in MY during exercise, which is attributable to heat loss due to the greater surface area to mass ratio and large number of arteriovenous anastomoses. Also, the smaller increase in T(re) in MY may be explained by the presence of a significantly greater core-skin temperature gradient in MY than JP. The thermal gradient is also a major factor in increasing the convective heat transfer from core to skin as well as skin blood flow. It is concluded that the greater core-skin temperature gradient observed in MY is responsible for the smaller increase in T(re).

Matched MeSH terms: Body Temperature Regulation/physiology*
Fulltext Alteration of foot temperature in diabetic neuropathy: is it another piece of puzzle?

Naicker AS, Roohi SA, Lee CS, Chan WH, Tay LS, Din XJ, et al.

Med J Malaysia, 2006 Feb;61 Suppl A:10-3.
PMID: 17042221

Poor glycaemic control and the duration of diabetes mellitus are known to accelerate development and progression of neuropathy. Diabetic co-morbidities: hypertension and hyperlipidaemia, have been postulated to associate with development of neuropathy. A diabetic foot with low temperature and frequent exposure to low temperature environment has recently been hypothesized to be at higher risk to develop early neuropathy. This cross-sectional study is undertaken to identify risk factors for diabetic neuropathy and the association between foot temperature and development of diabetic neuropathy by using simple clinical examination in the outpatient setting. From April 18, to April 30, 2005, universal sampling method was used to select 134 diabetic patients (type 1 or type 2 for >1 year) with peripheral neuropathy. Excluded are those with chronic alcoholism, drug-induced neuropathy, dietary history of vitamin B deficiency and family history of porphyria and hereditary sensorimotor neuropathy. The patient's duration of diabetes, glycaemic control status and the presence of co-morbids: hypertension and hyperlipidemia, were recorded. The temperature of the foot was measured by using thermo buddy. Of 134 patients representing Malaysian ethnic distribution with an equal number of males and females, 20.1% were in the age group of 61 to 65 years and, 85.1% and 67.9% belonged to lower socioeconomic and educational groups respectively. Associations between diabetic neuropathy and glycaemic control (p = 0.018) and duration of diabetes (p < 0.05) were significant. However, hypertension, hyperlipidaemia and low foot temperature were not significantly associated with development of diabetic neuropathy. Poor glycaemic control is significantly associated with diabetic neuropathy. Foot temperature alteration is merely an effect of autonomic neuropathy with a cold foot is attributed to co-existing peripheral arterial disease.

Study site: Pusat Perubatan Primer Bandar Tasik Selatan, Kuala Lumpur, Malaysia

Matched MeSH terms: Body Temperature Regulation/physiology
Anthropometric status and resting metabolic rate in users of the areca nut and smokers of tobacco in rural Sarawak

Strickland SS, Duffield AE

Ann Hum Biol, 1997 Sep-Oct;24(5):453-74.
PMID: 9300122

The areca nut is chewed by many of the world's population, mainly in South and Southeast Asia. Anthropometric data for 458 Sarawaki adults aged over 24 years, measured both in 1990 and in 1996, were examined in relation to use of tobacco and areca nut. Compared to non-smokers, smoking men were significantly taller and slightly (not significantly) thinner in both years, while smoking women were thinner in 1990 and slightly (not significantly) thinner in 1996. In both sexes there was an increase in the mean and range of body mass index (BMI, W/H2) over the 6-year interval. Smoking women showed a significantly smaller increment in BMI after allowing for areca nut use, which was associated with a similar trend, and this finding depended on including areca use in the model. The trend for men was similar. Possible effects of areca use could reflect variation in 'affluence' or conservatism, or appetite suppression. However, resting metabolic rate in 54 men and 70 women aged 24-60 years was associated with areca use. This association appeared to be mediated by the maximum room temperature of the 24 h preceding measurement. In women, a significant curvilinear association of RMR with maximum temperature was found in users of areca nut but not in non-users. In men, RMR was 7% higher (p < 0.05) in users of areca nut than in non-users, after allowing for age, height, weight, the sum of four skinfold thicknesses, and haemoglobin, but the association with maximum temperature was similar in both groups. It is speculated that constituents of areca nut modulate thermoregulatory pathways, resulting in prolonged temperature-dependent and hyperthermic heat production in this population; that males are more responsive to this effect than females; and that by this mechanism, and possibly also through centrally mediated effects on appetite for food, areca use could contribute to long-term variation in energy balance represented by change in BMI.

Matched MeSH terms: Body Temperature Regulation/physiology
Fulltext Once- and twice-daily heat acclimation confer similar heat adaptations, inflammatory responses and exercise tolerance improvements

Willmott AGB, Hayes M, James CA, Dekerle J, Gibson OR, Maxwell NS

Physiol Rep, 2018 Dec;6(24):e13936.
PMID: 30575321 DOI: 10.14814/phy2.13936

This experiment aimed to investigate the efficacy of twice-daily, nonconsecutive heat acclimation (TDHA) in comparison to once-daily heat acclimation (ODHA) and work matched once- or twice-daily temperate exercise (ODTEMP, TDTEMP) for inducing heat adaptations, improved exercise tolerance, and cytokine (immune) responses. Forty males, matched biophysically and for aerobic capacity, were assigned to ODHA, TDHA, ODTEMP, or TDTEMP. Participants completed a cycling-graded exercise test, heat acclimation state test, and a time to task failure (TTTF) at 80% peak power output in temperate (TTTFTEMP : 22°C/40% RH) and hot conditions (TTTFHOT : 38°C/20% RH), before and after 10-sessions (60 min of cycling at ~2 W·kg-1 ) in 45°C/20% RH (ODHA and TDHA) or 22°C/40% RH (ODTEMP or TDTEMP). Plasma IL-6, TNF-α, and cortisol were measured pre- and postsessions 1, 5, and 10. ODHA and TDHA induced equivalent heat adaptations (P 0.05) following ODHA (+14 ± 4%), TDHA (14 ± 8%), ODTEMP (9 ± 10%) or TDTEMP (8 ± 13%). Acute (P 0.05) increases were observed in IL-6, TNF-α, or cortisol during ODHA and TDHA, or ODTEMP and TDTEMP. Once- and twice-daily heat acclimation conferred similar magnitudes of heat adaptation and exercise tolerance improvements, without differentially altering immune function, thus nonconsecutive TDHA provides an effective, logistically flexible method of HA, benefitting individuals preparing for exercise-heat stress.

Matched MeSH terms: Body Temperature Regulation
Significant factors influencing inadvertent hypothermia in pediatric anesthesia

Lai LL, See MH, Rampal S, Ng KS, Chan L

J Clin Monit Comput, 2019 Dec;33(6):1105-1112.
PMID: 30915603 DOI: 10.1007/s10877-019-00259-2

Thermal imbalances are very common during surgery. Hypothermia exposes the patient to post-operative shivering, cardiac dysfunction, coagulopathy, bleeding, wound infection, delayed anesthesia recovery, prolonged hospital stay and increased hospitalization cost. There are many factors contributing to intraoperative hypothermia. This is a prospective cohort study conducted through observation and measurement of pediatric surgical patients' temperature. Convenience sampling methods were used in this study. Initial skin temperature and core temperature at 10 min, 30 min,1 h, 2 h, 3 h, 4 h, 5 h, 6 h and at the end of surgery were recorded. Body temperature was monitored from time of transfer to the operating table until recovery and discharge to the respective pediatric ward. The overall incidence of intraoperative hypothermia was still very high at about 46.6% even though active and passive temperature management were carried out during surgery. Patient's age, body weight, duration of surgery, type of surgery, intraoperative blood loss, type of anesthesia and operating room temperature were factors that contributed to intraoperative hypothermia. Hypothermia is common in surgery, especially in major and long duration surgery. Intraoperative hypothermia can be life threatening if it is not handled carefully. Various methods are used before, during and after surgery to maintain a patient's body temperature within the normothermia range. The use of an active warming device like the Bair Hugger® air-forced warming system seems to be a good method for reducing the risk of intraoperative hypothermia and effectively maintaining body temperature for all major and minor surgeries.

Matched MeSH terms: Body Temperature Regulation

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