Recent discussions
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Amol Joshi
Methods of recording of temperature in preterm babies (1) 1. Average time taken by conventional clinical thermometer is 3 – 5 minutes. 2. Time taken by an electronic thermometer by axillary skin temperature is lesser and varies with make and temperature of the baby. 3. We need a method to record the temperature which should be simple, rapid, non-invasive, reproducible(2), cost-effective and accurately reflect the neonate's core body temperature (3), preferably without uncovering the baby. In extremely preterm babies, we recommend using food-grade plastic for transport from the labor room to NICU to prevent hypothermia. 4. The infrared tympanic thermometer has been shown to accurately reflect core temperatures when used in a pediatric population aged 6 months to 15 years. The limited data regarding its accuracy in neonates have reported promising results. The tympanic measurements were significantly higher than electronic axillary temperatures by 0.19 to 0.22°C (4). However, only 12 neonates were included within this study and hence larger-scale studies are needed to determine its accuracy in preterm babies. When mid-forehead measurements were compared to electronic axillary thermometry in neonates nursed in incubators, temperatures measured by the two methods did not differ to a clinically significant degree(5). However, a study in healthy preterm neonates compared the axillary with tympanic membrane temperature recordings noted that they are safe, accurate, easy, and comfortable for the baby sites(6). 5. The methods for recording temperature may vary in facility based and community settings and for spot and continuous recording of temperatures. Methods to keep baby warm: A portable, non-electric, ready to use, and air-activated warm blanket that is designed specifically to support premature, low birth weight newborn children to maintain thermoneutral temperature during transport. It gets activated with a exothermic reaction on exposure to air. It is a single use device capable of maintaining warm temperature for 6- 8 hours. Evidence is lacking. https://parisodhana.org/NeoWarm/#home 1. Lei D, Tan K, Malhotra A. Temperature Monitoring Devices in Neonates. Frontiers in Pediatrics. 2021:890. 2. Jirapaet V, Jirapaet K. Comparisons of tympanic membrane, abdominal skin, axillary, and rectal temperature measurements in term and preterm neonates. Nurs Health Sci. (2000) 2:1–8. doi: 10.1046/j.1442-2018.2000.00034.x 3. Bailey J, Rose P. Axillary and tympanic membrane temperature recording in the preterm neonate: a comparative study. J Adv Nurs. (2001) 34:465–74. doi: 10.1046/j.1365-2648.2001.01775.x 4. Weiss ME. Tympanic infrared thermometry for fullterm and preterm neonates. Clin Pediatr. (1991) 30(4 Suppl):42–5; discussion 9. doi: 10.1177/0009922891030004S12 5. Smith J. Are electronic thermometry techniques suitable alternatives to traditional mercury in glass thermometry techniques in the paediatric setting? J Adv Nurs. (1998) 28:1030–9. doi: 10.1046/j.1365-2648.1998.00745.x 6. Bailey J, Rose P. Axillary and tympanic membrane temperature recording in the preterm neonate: a comparative study. Journal of advanced nursing. 2001 May 7;34(4):465-74. -
Luciane Berti
I agree with the agent -
ANA CAVANHA
It seems reasonable to me to try to use a temperature of 23 degrees Celsius in the delivery room to reduce cases of hypothermia, as it would be a low-cost action. -
Gabriel Variane
Despite the paucity of evidence, our center recommends that room temperatures of 23oC be used at birth for late preterm ( ≥34 weeks' gestation) and term infants and also that skin to skin care be used immediately after birth. We do not routinely recommend the use of a plastic bag or wrap in addition to skin to skin care in this population, as the risk-benefit of specific interventions is unknown. I agree that studies examining the effectiveness of interventions are necessary to make these treatment recommendations and that standardizing the timing and method of temperature recording for all infants would be an important step. -
LEONARDO DE SIQUEIRA
Very important maintaining a normal temperature after birth to all preterm and term infants. -
Jaqueline Tonelotto
I agree with recomendation of operating room temperature to 23ºC, we already practice it. -
José Roberto Ramos
Very relevant and difficult topic to comment on. I believe there are 2 important variables in addition to all those mentioned: different preterm and term physiologies and resuscitation needs or not, making it difficult to maintain the desired temperature for a long time. The successful experience of skin-to-skin contact in Brazil has played an important role and the decision to put all terms in the plastic bag still seems to me to have an uncertain risk-benefit -
Andrea Lube
Maintaining the proper temperature is a major challenge. We have been practicing golden hour with maintaining skin-to-skin contact for about 1 hour or more. Yet we face problems with colleagues who want a low ambient temperature in these late preterm and especially term deliveries. Maternal temperature is often low, and we don't know how much this can impact the newborn's temperature. We occasionally use gel mattresses. But we are afraid of burning the skin or causing hyperthermia, as we have no control over the temperature of the mattress. The imported thermal mattress is expensive and single-use. The use of plastic bags may help us to maintain the proper temperature. -
Bettina Figueira
The maintenance of the adequate temperature of the newborn(NB) is an important issue in stabilization at birth, since both hyper and unscheduled hypothermia are able to negatively modify the evolution of the neonate. The early skin-to-skin contact of the NB with his/her mother has been shown to be importante not only in maintainnig body temperature but also in the humanization, bonding, initiation and maintenance of breastfeeding with its beneficial both in the neonatal out come and in the future life of this small being. Considering a tropical country like ours, most newborns with gestational age of 34 weeks or more who do not require resuscitation interventions, stay well with skin-to-skin contact with their mother, covered (not wrapped) by a sterile cloth. In the impossibility of performing skin-to-skin contact due to some maternal limitation, for example, the routine measures of receiving the NB in pre warmed cloth, drying, removing the wet clots and positioning under radiant warmer, apparently has not been shown to be effective in preventing hypothermia in these newborns (Lunze 2013). Additional measures for temperature maintenance should be based on the assessment of local reality and ideally on the monitoring of the newborn`s body temperature. The increase in ambiente room temperature from 20° to 23°C is an objective measure that may contribute to the prevention of hypothermia in those births that occur in a surgical hospital environment. Wrap the NB or put him in a plastic bag before placing on the skin-to-skin contact with the mother, results in the loss of exactly the skin-to-skin contact and we do not know if there will be or not a lost of the benefits described by this technique in breastfeeding and mother-baby bonding. In babies who, for some reason, are not eligible for this early contact, wrapping or placement in plastic bag, may be a good option to maintain temperature. -
Jamson Barreto
Maintenance of temperature in all the newborns, regardless the gestacional age is clearly important. I think that the most effective strategy to avoid low temperatures at the admission in NICUs or postnatal ward must be combined, since the admission of the mother inside the surgical room, maintaining her normothermia, till the control of temperature of the admission rooms or the use of adequate devices to keep the newborn warmed.