BACKGROUND: Moderate hypothermia (temperature ,36°C) at birth is common in premature infants and is associated with increased mortality and morbidity.METHODS: A multidisciplinary practice plan was implemented to determine in premature infants ,35 weeks old whether a multifaceted approach would reduce the number of inborn infants with an admitting axillary temperature ,36°C by 20% without increasing exposure to a temperature .37.5°C. The plan included use of occlusive wrap a transwarmer mattress and cap for all infants and maintaining an operating room temperature between 21°C and 23°C. Data were obtained at baseline (n = 66), during phasing in (n = 102), and at full implementation (n = 193).RESULTS: Infant axillary temperature in the delivery room (DR) increased from 36.1°C 6 0.6°C to 36.2°C 6 0.6°C to 36.6°C 6 0.6°C (P , .001), and admitting temperature increased from 36.0°C 6 0.8°C to 36.3°C 6 0.6°C to 36.7°C 6 0.5°C at baseline, phasing in, and full implementation, respectively (P , .001). The number of infants with temperature ,36°C decreased from 55% to 6.2% at baseline versus full implementation (P , .001), and intubation at 24 hours decreased from 39% to 17.6% (P = .005). There was no increase in the number of infants with a temperature .37.5°C over time. The use of occlusive wrap, mattress, and cap increased from 33% to 88% at baseline versus full implementation. Control charts showed significant improvement in DR ambient temperature at baseline versus full implementation. CONCLUSIONS:The practice plan was associated with a significant increase in DR and admitting axillary infant temperatures and a corresponding decrease in the number of infants with moderate hypothermia. There was an associated reduction in intubation at 24 hours. These positive findings reflect increased compliance with the practice plan. Dr Russo helped develop the practice plan and the algorithms, helped collect and oversee the data, and was involved in writing the manuscript; Ms McCready and Ms Venturini helped develop the practice plan and the algorithms and were involved in writing the manuscript; Ms Torres helped develop the practice plan and the algorithms, facilitated temperature regulation of the operating room and implementation of the practice plan in labor and delivery, and was involved in writing the manuscript; Ms Theuriere helped develop the practice plan and the algorithms and in review of the data and was involved in writing the manuscript; Dr Spaight helped in the data collection and was involved in writing the manuscript; Ms Hemway helped develop the practice plan and collect data and was involved in writing the manuscript; Ms Handrinos helped develop the practice plan; Ms Perlmutter and Drs Huynh and Grunebaum helped develop the practice plan and were involved in writing the manuscript; Dr Perlman was involved in developing and implementing the practice plan, conceptualized and designed the study, contributed to design of the analyses and interpretation of the results, and took the lead in drafting the init...

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The role of the Neonatal Nurse Practitioner has been evolving since the early 1970s. The original concept and design was born out of individual hospital's needs for highly professional and skilled personnel at the bedside. Thus, initial programs were hospital-based and granted certificates. Over the past 20 years, a gradual shift toward graduate degrees and standardization of programs has been seen. The role and responsibilities of the neonatal nurse practitioner have also expanded over that time period. From their strictly clinical beginnings, neonatal nurse practitioners now contribute to research, nursing and medical education, and administration. This article looks at the neonatal nurse practitioner role and the impact that education and legislation have had on its evolution.

Objective. To determine whether it is necessary to delay discharge of newly circumcised male neonates to observe voiding. Subjects and Methods. A prospective study was conducted in 1992 and 1993 of 51 healthy male, newly circumcised neonates between 0 and 10 days of age. The neonates were observed for the time of first voiding after circumcision was performed. Results. All neonates voided after circumcision at a mean age of 5.3 ± 2.5 hours, and there were no complications noted in the study population. Conclusion. Healthy male infants who are circumcised without obvious complications can be expected to void, and it is unnecessary to delay hospital discharge to make this observation.

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