Goals and options in keeping preterm babies warm

Lyon, Andrew; Freer, Yvonne

doi:10.1136/adc.2009.161158

Cited by 43 publications

(33 citation statements)

References 39 publications

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“…[1][2][3][4][5][6][7][8][9][10] The immature infant is at high risk of net heat loss because of a high surface area to volume ratio and increased evaporative fluid losses from the skin. 11 Strategies introduced to minimize heat loss include occlusive wrapping, exothermic warming mattresses, warmed humidified resuscitation gases, polyethylene caps, and higher delivery room (DR) temperatures. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Despite these interventions, hypothermia still occurs in a substantial number (10%-35%) of infants.…”

Section: Resultsmentioning

confidence: 99%

“…33 Investigators have evaluated different interventions, predominantly in VLBW infants ,1500 g or a GA ,30 weeks, to prevent heat loss, including using occlusive wrap, exothermic mattresses, warm caps, polyethylene caps, or heated humidified air or raising the OR temperature either singularly or in combination, with varied success. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Because of baseline data demonstrating frequent hypothermia in the larger premature infant, the combination approach of wrap, exothermic mattress, and cap was extended to all infants ,35 weeks old. Indeed, the greatest impact of the QI was noted in these infants.…”

Section: Discussionmentioning

confidence: 99%

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Reducing Hypothermia in Preterm Infants Following Delivery

et al. 2014

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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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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reducing Hypothermia in Preterm Infants Following Delivery

et al. 2014

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“…In 1878, his local colleague Stéphane Tarnier, using a modified warming chamber for the rearing of poultry, found a decrease in neonatal death rate from 66 to 38% among infants with birth weights <2000 g. 67 Today, postnatal care devices (isolettes or infant warmers) combine the features of incubators and radiant warmer beds and have evolved with many features, including automated temperature and humidity regulations, 68 oxygen supplementation and light therapy. 11,69 Although beneficial in resource-replete settings, 70 utilization of their complex features requires electricity, concentrated oxygen supply, centralized suction and ongoing skilled maintenance. Priced at about US$15 000 to $36 000, 71 these devices are not affordable for most of the developing world.…”

Section: Diagnosismentioning

confidence: 99%

Thermal protection of the newborn in resource-limited environments

2012

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Appropriate thermal protection of the newborn prevents hypothermia and its associated burden of morbidity and mortality. Yet, current global birth practices tend to not adequately address this challenge. Here, we discuss the pathophysiology of hypothermia in the newborn, its prevention and therapeutic options with particular attention to resource-limited environments. Newborns are equipped with sophisticated mechanisms of body temperature regulation. Neonatal thermoregulation is a critical function for newborn survival, regulated in the hypothalamus and mediated by endocrine pathways. Hypothermia activates cellular metabolism through shivering and nonshivering thermogenesis. In newborns, optimal temperature ranges are narrow and thermoregulatory mechanisms easily overwhelmed, particularly in premature and low-birth weight infants. Hyperthermia most commonly is associated with dehydration and potentially sepsis. The lack of thermal protection promptly leads to hypothermia, which is associated with detrimental metabolic and other pathophysiological processes. Simple thermal protection strategies are feasible at community and institutional levels in resource-limited environments. Appropriate interventions include skin-to-skin care, breastfeeding and protective clothing or devices. Due to poor provider training and limited awareness of the problem, appropriate thermal care of the newborn is often neglected in many settings. Education and appropriate devices might foster improved hypothermia management through mothers, birth attendants and health care workers. Integration of relatively simple thermal protection interventions into existing mother and child health programs can effectively prevent newborn hypothermia even in resource-limited environments.

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“…All the differences between methods were statistically significant (P<0,001). We never observed a difference between rectal and axillary/forehead temperature greater than 2°C, which could indicate 'cold stress' [20]. Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The agreement between the two methods could be due to the thermo-neutral environment where preterm infants were maintained. It has been found that preterm infants have a smaller core-surface temperature gradient because of their relative lack of thermal insulation by body fat [13,20].…”

Section: Discussionmentioning

confidence: 99%

Rectal, Axillary or Skin Temperature in Newborns?

Merusi¹

2014

J Preg Child Health

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Background: Hypothermia in newborns is strongly associated with increased morbidity. Despite its importance, where and how temperature should be measured is not still clearly defined. Aim:To compare sites and instruments for measuring temperature in newborns to estimate differences and limits of agreement.Patients: Sample: 107 healthy term newborns. The temperature was measured in three different body sites (forehaed, axilla and rectum), using three different thermomethers.Results: Mean ± DS rectal temperature was 36.9 ± 0.4°C, mean axillary temperature was 36.5 ± 0.4°C, mean skin temperature was 36.1 ± 0.4°C. The mean rectal-axillary temperature difference was 0.3 °C (limits of agreement -0.30 to 0.92); the mean axillary-skin difference was 0.35°C (limits of agreement -0.45 to 1.17); the rectal-skin difference was 0.67°C (limits of agreement -0.05 to 1.40). All the differences between methods are statistically significant. Infants born after a cesarean section had a slightly lower temperature than after vaginal delivery. Conclusions:Observed values of temperature depend on site and type of thermometer used.Since the measure in different sites produces different results, it seems necessary to define an objective way to assess it. The core-peripheral temperature difference may detect a thermal stress.mother-infant bonding and breastfeeding, while infrared forehead measurement would not, because of its lack of body contact. Given all these uncertainties, the aim of the study was to compare different instruments for measuring temperature in different sites of the body in a sample of newborns at birth, to estimate differences and limits of agreement. PatientsWe studied a sample of 107 healthy (i.e not requiring any special care) term newborns. All these newborns had an uneventful delivery, and followed the usual routine of care of our hospital: for the first two hours after delivery, mother and baby were transferred in a post-delivery room with a controlled temperature of 24°C. During this observation period, the babies stayed with their mothers, covered with clothes after being bathed and dried. After this time mothers and infants were transferred to the ward, where we carried out the measurements. MethodsFor each infant, the temperature was measured by the same nurse in three different body sites (forehaed, axilla and rectum), using three different thermometers specifically designed for each site, at two hours of life. Rectal temperature was assessed by digital thermometer Chicco Artsana; axillary temperature by electronic themometer Journal of Pregnancy and Child Health

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Goals and options in keeping preterm babies warm

Cited by 43 publications

References 39 publications

Reducing Hypothermia in Preterm Infants Following Delivery

Reducing Hypothermia in Preterm Infants Following Delivery

Thermal protection of the newborn in resource-limited environments

Rectal, Axillary or Skin Temperature in Newborns?

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