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The decreased ability of the preterm neonate to produce heat to maintain normal body temperature is most related to

Immature hypothalamus

Lack of shivering reflex

Limited subcutaneous tissue and brown fat stores

Non-shivering thermogenesis using brown adipose tissue is how newborns generate heat. Preterm infants have very little brown fat and thinner subcutaneous tissue, so they lack the primary means to produce and retain heat. This makes maintaining normal body temperature particularly difficult. While an immature hypothalamus or absent shivering reflex can affect temperature regulation, they don’t account for the main limitation in heat production. A high metabolic rate would increase heat needs rather than explain reduced heat generation.

High metabolic rate

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