Contemporary Challenges in Thermal Homeostasis: Time for a Rethink?

We suggest reframing neonatal thermal care as actively managing thermal and vapour gradients, rather than only maintaining core normothermia. Evidence-based strategies include keeping high relative humidity soon after birth, minimising isolette openings, pre-warming contact surfaces, and recognising dew point thresholds. Research priorities involve defining optimal humidity protocols, measuring circuit thermal load, and validating monitoring systems that combine oxygen consumption with environmental factors. Tackling these gaps may reduce metabolic stress, enhance survival, and optimise outcomes for the most vulnerable infants. .