Designing a team-based patient safety event to take place towards the end of medical education can enable students to assimilate all aspects of their curriculum relevant to safety. The link between team factors and the safety agenda is increased when students learn interprofessionally.

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SUMMARY The thermal insulation of clothing and wrapping (tog value), room temperature, and body temperature was measured for 3-4 month old infants sleeping in their home cots under conditions chosen freely by parents during a cold winter. We found that ambient temperature averaged 18-4°C when infants were put down, but fell by an average of 4-4°C during the night. Minimum room temperature correlated with outside temperature, but most rooms were heated to some degree; smaller babies were kept in warmer rooms. The tog value of clothing before putting the baby down averaged 5-1, supplemented by 9-6 tog units of wrapping in the cot-a 188% increase for a 4-40C drop in temperature.Total tog of clothing and wrapping correlated negatively with minimum room temperature; smaller born babies tended to be more heavily wrapped. Despite the large increase in insulation in the cot, most babies maintained normal body temperatures.Over the last couple of decades there has been a substantial increase in the variety of items for clothing and wrapping of babies, and a rise in the number of homes with central heating. There are few reports, however, of the thermal consequences of the way in which parents now clothe and wrap their babies. 1 Recent reports of raised core temperature in some sudden infant deaths,2 and subsequent retrospective analysis of clothing and wrapping,3 have suggested that 'over wrapping' may be a contributory factor, but is not clear how 'over wrapping' can be defined as we have no precise information about either the range of normal parental behaviour or how it affects infant thermoregulation.In this study we report data on the room temperatures to which normal 4 month old infants were exposed at home during the night, the extent to which they were clothed and wrapped, and the factors that parents took into account in deciding the appropriate combination of room heating and coverings for sleeping babies during a cold British winter. Subjects and methodsInformation on a random sample of normal, full term, singleton babies was collected at birth, and permission obtained from parents for the body temperature to be monitored for one night during sleep between the ages of 3-4 months. At this time each child was visited at home, weighed, skin fold thickness measured, and information obtained on feeding pattern and the recent health of the baby. Three thermistor probes were securely attached to the baby: (a) at the centre of the forehead; (b) on the abdomen 3 cm to the left of the umbilicus; and (c) into the rectum 5 cm from the anal margin.

Subjects and methods Subjects were recruited at birth in the Leicester General and Royal Infirmary maternity hospitals. The purpose of the study was explained to parents and permission sought to make continuous night time recordings of temperature at two to four week intervals over the next six months. If parents agreed basic perinatal data were collected from hospital notes, and in most cases a recording of the baby's body temperature (see below) was made before leaving the hospital.The subsequent inter-recording intervals for each baby were adjusted so as to try and record from roughly equal numbers of babies in each two week age band from 0 to 24 weeks. Inevitably, some babies were lost to the study. They were replaced with others on which recording started at a later age.On each recording night the baby was visited at home in the early evening, weighed naked, and temperature probes attached. One soft probe, inserted 5 cm from the anal margin, measured rectal temperature, and other probes recorded skin temperature on the head and either the abdomen or shin. Only rectal temperature data will be discussed in this paper

The rectal temperature of 26 infants between 6 and 16 weeks old was monitored continuously for one night each week. Rectal There appeared, however, to be considerable individual differences in the age at which this pattern appeared. This paper reports longitudinal studies of individual infants which confirm these differences, and shows some factors affecting the timing of development of night time temperature rhythms.Subjects and methods Thirty normal healthy full term infants were recruited at or just after birth by liaison with general practitioners and health visitors in Leicestershire. Parents gave informed consent to weekly overnight recordings of body temperature from 6 to 16 weeks of age. Basic perinatal data were collected at the time of recruitment and parents were provided with a diary to record prospectively any episodes of illness in the infant.Once each week from 6 weeks' old the infant was visited at home in the evening, weighed naked, and data collected on the current feeding regimen, other aspects of parental care, and the health of the infant and family. Probes were then attached to record body temperature. A soft probe, inserted 5 cm from the anal margin, recorded rectal temperature and a skin thermistor measured surface temperature on the skin. Only rectal temperature data are described here. A third probe measured ambient temperature near the infant. All three probes were connected to a Grant Squirrell data logger, set to sample at one minute intervals throughout the night. These techniques are safe,' and full ethical approval was obtained for the study.Parents were asked to keep a detailed diary of all events throughout each night of recording, including feeds, nappy changes, periods of waking, and administration of any drugs. Note was also made of infant's clothing and bedding so that a thermal insulation or 'tog' value could be calculated according to tables provided by the Shirley Institute (Manchester).The next day the data loggers were collected and the data downloaded to a computer. They were analysed for technical problems such as loss of probes and only unblemished data were analysed further. For each night of recording rectal temperature was abstracted at 30 minute intervals from one hour before bedtime until nine hours later. ResultsTwenty six of the 30 subjects yielded sufficient data to be certain of the individual pattern of development, a total of 246 nights of recording. For the remaining four infants data were not available for one or more weeks around the critical age for a variety of reasons. The mean (SD) gestational age of the 26 infants was 39-9 (1 -5) weeks, with all but one born between 38 and 42 weeks and none before 36 weeks. The birth weight averaged 3471 (485) g and 13 were boys. The average maternal age was 27-3 (4-6) years. Six of the infants had parents in occupational groups 1 or 2, and seven in groups 4 or 5, a social class distribution similar to that of the Leicestershire population as a whole. Nine were first children; three had two or more older ...