Maintaining thermal stability is vital for neonatal survival, particularly among preterm and low birth-weight infants who are prone to both hypothermia and hyperthermia due to immature thermoregulation. In resource-limited sick newborn care units (SNCUs), it is common for twin neonates to share a radiant warmer because of equipment constraints. However, conventional radiant warmers often provide uneven and non-individualized heat distribution, resulting in temperature fluctuations and increased risk of thermal imbalance.

This randomized controlled trial aims to evaluate the effectiveness of baby warmer cloths with adaptive thermoregulation properties compared to conventional radiant warmer-based twin sharing in preventing thermal dysregulation. The study will be conducted in the SNCU of a tertiary care teaching hospital over one year. Twin neonates with gestational age between 32 to 37 weeks and birth weight more than 1200 grams will be randomized into two groups: the intervention group, where adaptive thermoregulating cloths (using phase change materials) will be applied separately for each baby  in a twin-sharing cot, and the control group will receive  standard radiant warmer care only.

The primary outcome is the incidence of hypothermia (less than 36.5 degree celcius) and hyperthermia (more than 37.5 degree celcius) during the first 72 hours of life. Secondary outcomes include mean temperature trends, changes in daily weight, percentage of heater output of radiant warmer ( overall energy consumption), care giver satisfection and occurrence of adverse thermal events such as dehydration, incidence of sepsis in each group. Data will be analyzed using appropriate statistical tests (SPSS 25)

It is expected that neonates in the adaptive cloth group will experience fewer episodes of thermal instability, improved comfort, and reduced dependence on mechanical warming devices. The findings could support the integration of adaptive thermoregulating baby warmer cloths as a safe, sustainable, and cost-effective solution for neonatal thermal management, especially in twin-sharing scenarios and resource-limited healthcare settings.