In high-risk settings, including neonatal intensive care units, maintaining a neutral thermal environment in the high-risk infant is challenging and can affect the mortality and morbidity of newborns of all gestational ages. The mortality rate for newborns who become hypothermic is 5-fold higher when it occurs during the first 5 days of life, requiring evidence-based guidelines for practice.1 Premature infants are at the highest risk of hypothermia because, physiologically, they have thin skin and little adipose tissue. Despite advances in knowledge, equipment, and thermal support practices, thermal stability can be challenging for many infants, especially preterm infants. Preterm infants' inability to maintain euthermia places them at high risk for both morbidity and mortality. Term infants, despite their maturity, are also at risk for the development of hypothermia, which can precipitate other complications of birth. Strategies to maintain normothermia should be instituted for all infants from the time of delivery throughout the hospital stay.

To maintain normothermia, it is essential for caregivers to understand the complications resulting from hypo- or hyperthermia and its impact on infants. The thermoregulation guideline offers best practice recommendations for the maintenance of thermal neutrality in high-risk infants and includes the following:

* A review of skin physiology that informs the practice recommendations;

* Strategies to improve thermal stability at birth differentiated on the basis of varying gestational ages;

* Strategies to achieving and maintaining euthermia during the golden hour;

* Use of incubators, convertible beds, and open bed warmers in the prevention of hypothermia;

* Appropriate use of supportive warming devices such as blankets, humidity, hats, chemical mattresses, and plastic wraps;

* Recommendations for maintenance of thermal stability during intra- and interhospital transport; and

* Recommendations for maintaining euthermia before, during, and after surgical interventions.

This practice guideline will assist the obstetrical, postpartum, and neonatal nurses as well as other healthcare providers in providing appropriate thermal support/regulation in a variety of settings. Using the most current evidence-based research, the practice guideline provides direction for implementing best practices in the thermal management of the preterm, term, and postterm infants.

"Thermoregulation in the Care of Infants" is now available for purchase in the NANN bookstore at https://apps.nann.org/store/product-details?productId=104982587.

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