Why Keeping a Newborn Warm Is Lifesaving — and How One Hospital Made It Happen

A plain-language look at an Ethiopian study (Baracetti et al., Children 2025) that used simple, low-cost steps to protect babies from getting dangerously cold

A hospital in rural Ethiopia showed that a bundle of simple, inexpensive warming steps — training staff, warming rooms before birth, dressing babies in hats and socks, and checking temperatures carefully — helped newborns arrive and stay warmer during their hospital stay. Babies were warmer on admission and had far fewer episodes of dangerous cooling in the days that followed, and none became severely cold. The lesson is that protecting a baby's body heat is one of the cheapest and most powerful ways to protect their health [1].

Why a baby's temperature matters so much

Newborns are remarkably bad at staying warm. They are small, they have very little body fat for insulation, and their skin gives up heat quickly to the air, to cool surfaces, and through evaporation when they are wet. A grown adult who feels a bit chilly can shiver and put on a sweater; a newborn can do neither. When a baby's core temperature drops below about 36.5 °C — the threshold doctors call hypothermia — it is not just uncomfortable. Being cold forces the baby to burn precious energy and oxygen to generate heat, and it can set off a chain of problems including low blood sugar, breathing difficulty, and trouble with blood clotting [2].

These are not rare or minor risks. Across the world, studies have found that colder babies are more likely to become seriously ill or to die, and the relationship is strikingly consistent: the lower the temperature, the higher the danger. In one analysis of small babies, every single degree Celsius drop in temperature at admission was linked to roughly a 28% higher risk of death [3]. In many hospitals in sub-Saharan Africa, a large share of newborns arrive cold, and the consequences there are even more severe, partly because equipment and staffing are stretched thin [4].

The problem this study set out to solve

For a long time, most attention went to keeping babies warm in the first minutes after birth — the "delivery room" moment. That makes sense, because how warm a baby is on arrival to the newborn unit is a strong clue to how well they will do. But researchers noticed something important: a baby who is warm at first can still cool down over the following hours and days, and that later cooling carries its own risk of harm [5]. In other words, keeping a baby warm is not a single event at birth — it is a job that continues throughout the whole hospital stay.

To tackle this, the World Health Organization long ago described a "warm chain": ten linked steps that together keep a baby warm, from a heated delivery room and immediate drying, to skin-to-skin contact, breastfeeding, warm clothing, keeping mother and baby together, and training the staff who care for them [6]. The idea is powerful precisely because it is low-tech — most of the steps cost almost nothing. The catch is that following every link, every time, on a busy ward is genuinely hard. Most of the good evidence for warming babies had come from wealthier countries and focused on the delivery room, using tools like plastic wraps and warming mattresses; very little had been tested in the low-resource hospitals where cold babies are most common and most at risk [7]. This study aimed to help close that gap.

What the hospital did

The research took place at St. Luke Catholic Hospital in Wolisso, Ethiopia, a referral hospital that cares for around 900 newborns a year in a 16-bed unit [1]. Working with an Italian medical charity, the team introduced a package of warming measures in March 2024 and then compared how babies did before the changes (117 babies, December 2023 to February 2024) with how they did afterward (87 babies, April to June 2024). The two groups of babies were very similar to begin with — in size, in how they were born, and in why they needed care — which makes the comparison fairer.

The changes themselves were refreshingly ordinary. Staff, students, and even the mothers doing kangaroo care received a week of training on why warmth matters and exactly what to do. The delivery room was heated ahead of time with an electric radiator and a warming lamp, and a door was added to block cold draughts. Babies were dried immediately with pre-warmed towels, held skin-to-skin, and offered early breastfeeding. For the trip from the delivery room to the ward, babies were wrapped in pre-warmed cotton and wool blankets. On the ward — the part hospitals often overlook — every baby wore a hat and socks (and mittens if very small), got a blanket if not under a warmer, and had warming lamps placed nearby during jaundice light therapy so they would not cool while undressed. Staff were asked to recheck a baby's temperature after any cold episode and to tell the next shift, so no cold baby would be missed.

What happened

The babies got warmer, and the biggest improvement came during their stay on the ward rather than only at the moment of arrival [1]. On admission, the typical baby's temperature rose from 35.6 °C to 36.0 °C — a real improvement, though many babies were still a little too cold. But during the hospital stay, the typical temperature climbed from 36.3 °C into the healthy range at 36.7 °C, and the number of cold episodes each day dropped by about half. Importantly, no baby became severely cold after the changes. The length of hospital stay did not change, and although slightly more babies died in the second group, the study was far too small to draw any conclusion about survival — that difference could easily be down to chance.

Put simply, the bundle did not make every baby perfectly warm on arrival, but it did a good job of keeping babies warm across the days that followed — exactly the period that had been neglected before.

It also helps to understand why the improvement on admission was only modest. The team introduced all of these changes at once and then measured the results after just a few months. Experience from similar projects suggests that getting a whole hospital to reliably follow every step usually takes several rounds of trying something, seeing what works, and adjusting — not a single push. So the fact that babies were arriving somewhat warmer, and staying meaningfully warmer, after only one round of changes is genuinely encouraging rather than disappointing. It suggests there is more room to improve as the routine becomes second nature to the staff and families involved.

How families used to face this — and what it means for you

Before efforts like this, keeping a fragile newborn warm in a busy, under-resourced hospital often depended on individual staff remembering to do the right thing in the moment, without a shared routine or reliable equipment. A baby might be warmed well at birth and then slowly cool on the ward without anyone noticing until a problem appeared. Families were rarely told that they themselves — through skin-to-skin kangaroo care and simple bundling — were one of the most effective "warming devices" available. This study is part of a broader shift toward treating warmth as a continuous, shared responsibility, with clear steps everyone follows and parents included as active partners [8][9].

For families, the reassuring message is that the tools to protect a newborn's warmth are simple, safe, and something you can help with. Skin-to-skin contact is not only comforting and good for bonding — it is a genuine medical intervention that transfers your body heat to your baby [10]. A hat, a blanket, keeping the room warm, and keeping your baby close all matter. If your baby is in a newborn unit, it is completely reasonable to ask the staff how they are keeping your baby warm and how you can help.

What researchers are working on next

The team behind this study is clear that it was a first step, not a final answer [1]. Because it took place at a single hospital over a short time, and because it looked back at existing records rather than following a strict experiment, it cannot prove that the warming steps alone caused every improvement. The researchers plan to repeat and refine the approach, measure how consistently staff follow each step, and test it in more hospitals. The bigger question they hope to answer is whether keeping babies reliably warm throughout their stay — not just at birth — leads to fewer infections and more babies going home healthy [5]. Given how cheap and simple these measures are, that is a question well worth pursuing, and this study is an encouraging sign that the answer may be yes.

References

  1. Baracetti M, Hagos E, Tolera J, et al. Effectiveness of bundled interventions for the prevention of neonatal hypothermia in low-income settings: a quality improvement project in a referral hospital in Ethiopia. Children (Basel). 2025;12(6):709. doi:10.3390/children12060709 ↩
  2. Lunze K, Bloom DE, Jamison DT, Hamer DH. The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival. BMC Med. 2013;11:24. doi:10.1186/1741-7015-11-24 ↩
  3. Laptook AR, Salhab W, Bhaskar B. Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics. 2007;119:e643–e649. doi:10.1542/peds.2006-0943 ↩
  4. Cavallin F, Calgaro S, Brugnolaro V, et al. Non-linear association between admission temperature and neonatal mortality in a low-resource setting. Sci Rep. 2020;10:20800. doi:10.1038/s41598-020-77778-5 ↩
  5. Cavallin F, Calgaro S, Brugnolaro V, et al. Impact of temperature change from admission to day one on neonatal mortality in a low-resource setting. BMC Pregnancy Childbirth. 2020;20:646. doi:10.1186/s12884-020-03343-7 ↩
  6. Kumar V, Shearer JC, Kumar A, Darmstadt GL. Neonatal hypothermia in low resource settings: a review. J Perinatol. 2009;29:401–412. doi:10.1038/jp.2008.233 ↩
  7. Abiramalatha T, Ramaswamy VV, Bandyopadhyay T, et al. Delivery room interventions for hypothermia in preterm neonates: a systematic review and network meta-analysis. JAMA Pediatr. 2021;175:e210775. doi:10.1001/jamapediatrics.2021.0775 ↩
  8. Datta V, Saili A, Goel S, et al. Reducing hypothermia in newborns admitted to a neonatal care unit in a large academic hospital in New Delhi, India. BMJ Open Qual. 2017;6:e000183. doi:10.1136/bmjoq-2017-000183 ↩
  9. Wotango BY, Workineh WM, Abdana TD, et al. Decreasing incidence of admission neonatal hypothermia in Gandhi Memorial Hospital, Addis Ababa, Ethiopia: quality improvement project. BMJ Open Qual. 2024;13:e002656. doi:10.1136/bmjoq-2023-002656 ↩
  10. Trevisanuto D, Testoni D, de Almeida MFB. Maintaining normothermia: why and how? Semin Fetal Neonatal Med. 2018;23:333–339. doi:10.1016/j.siny.2018.03.009 ↩