Temperature Probe Placement during Preterm Infant Resuscitation: A Randomised Trial

Abstract

Background: Hypothermia on admission to intensive care is associated with poor outcomes in preterm infants. The neonatal resuscitation program recommends the use of servo-control thermoregulation during resuscitation. Very little evidence exists to guide optimal temperature probe placement in the delivery room. Objective: The aim of this work was to determine, in moderately preterm infants, if temperature probe placement in the dorsal, thoracic, or axillary area during delivery room resuscitation would result in differing temperatures on admission to the neonatal intensive care unit (NICU). Methods: A randomised trial with 3 arms was conducted. In total, 122 inborn preterm infants born between 28^0/7 and 35^6/7 weeks of gestational age were recruited. The infants were randomly assigned to thermal probe placement in the left lower back, left upper thorax, or left axilla immediately after birth. Temperature was servo-controlled using an infant resuscitation table set to 36.5°C. The primary outcome was axillary temperature at admission to the NICU before transfer to a closed isolette, recorded with a digital thermometer. The secondary outcomes assessed were temperature within the target range (36.5-37.5°C), hypothermia (<36.5°C), and hyperthermia (>37.5°C). Results: All 122 infants were available for outcome analysis. The groups were comparable for birthweight, gestational age, and sex. The mean admission temperature was comparable between the 3 probe positions (mean, 95% CI): dorsum (36.7°C, 36.6-36.8), thorax (36.8°C, 36.7-36.9), and axilla (36.7°C, 36.6-36.9), p = 0.43. The proportion of infants with admission temperatures in the target range was comparable (87.2, 81.4, and 72.5% respectively), p = 0.44. Conclusion: Dorsal, thoracic, or axillary temperature probe positioning during resuscitation yield similar admission temperatures in moderately preterm infants. Further studies are required in infants below 28 weeks of gestation to determine the best practice.

Temperature probe placement in very preterm infants during delivery room stabilization: an open-label randomized trial

“…3 Variation in practice exists for the site of securing a temperature probe during DR stabilization. 9 Bensouda et al found comparable body temperatures at admission to the NICU when three different sites of temperature probe positioning (left lower back, left upper thorax, and left axilla) were compared in preterm infants ≥28 weeks GA. 10 In our unit, despite an improvement in normothermia after introducing a thermoregulation bundle for very preterm infants (<32 weeks GA) during DR stabilization, some infants continued to develop hypothermia. 11 The current study was designed to test the hypothesis that application of a temperature probe to the left upper back during DR stabilization will achieve a higher proportion of normothermia at the time of NICU admission than application in the left axilla in very preterm infants.…”

Optimising homeothermy in neonates: A systematic review and clinical guidelines from the French Neonatal Society

“…The skin temperature measured with a probe under an occlusive, reflective patch is well correlated with the core temperature and can be monitored as a reliable, alternative guide to the body's temperature when necessary 19,20 . Furthermore, the part of the trunk, axillary, flank or back to which the probe is attached appears to have little to no influence on the temperature value when the said probe is placed under an occlusive, reflective patch 23 . The use of two skin probes allows the detection of probe detachments and the monitoring of the gradient between core and peripheral temperatures 2,24 .…”

“…19,20 Furthermore, the part of the trunk, axillary, flank or back to which the probe is attached appears to have little to no influence on the temperature value when the said probe is placed under an occlusive, reflective patch. 23 The use of two skin probes allows the detection of probe detachments and the monitoring of the gradient between core and peripheral temperatures. 2,24 The peripheral temperature is then measured on the end of a limb, with the probe again covered by a reflective patch.…”

Thermoregulation and golden hour practices in extremely preterm infants: an international survey

“…Bensouda et al recorded similar admission temperatures in moderate preterm infants from temperature-probe placement on the axilla, left upper and left lower back. 17 A single centre randomised control trial in Australia is currently recruiting preterm infants <32 weeks gestation to ascertain the effect of temperature-probe placement in the axilla compared to the left upper back during delivery room resuscitation on admission body temperature (ACTRN12620000293965).…”