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SOUTHERN HEALTH & SOCIAL CARE TRUST. Children & Young People s Directorate Procedure/Guidelines/Protocol Checklist & Version Control Sheet

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Children & Young People’s Directorate

Procedure/Guidelines/Protocol Checklist & Version Control Sheet

1

Name of Procedure/Guidelines/

Protocol:

Temperature Management in a Neonate

2

Purpose of Procedure/

Guidelines/ Protocol:

To provide guidance on temperature

management in the neonate

3

Replaces:

New

4

Applicable to which staff:

Neonatal and SCBU nursing staff

5

Name & title of author:

Una Toland Lead Nurse Neonatal

Services and ANNP team SH&SCT

6

Equality Screened by:

Note any issues:

N/A

7

Proposals for dissemination:

Una Toland via team managers to

nursing staff

8

Proposals for implementation:

With immediate effect

9

Training Implications:

To be included in induction training of all

new nursing staff

10 Date Procedure/Guideline/

Protocol submitted to

Procedures Committee:

31-03-13

11 Outcome: Approved

Comment:

Approved/Minor

amendments

Not approved

Deferred

12 Date of CYP SMT approval

Comments:

13 Date of approval by Trust SMT

(if required):

14 Date approved by HSCB (Social

Work only):

15 Date for further review (3 year

default):

16 Date added to repository:

17 Date added to Intranet:

State where to be placed on

Intranet:

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TEMPERATURE MANAGEMENT IN NEONATES

Incubators are designed to minimise heat loss and provide a neutral thermal environment.

The neutral thermal environment is the temperature range where heat production is at the minimum to maintain body temperature.

Preterm infants are cared for in a neutral thermal environment to prevent thermal cold stress so that minimal energy is expended thereby minimising oxygen and energy consumption. The infant is challenged by cold and attempts to increase its heat production to maintain body temperature. Vasoconstriction occurs as the infant attempts to conserve body heat and brown adipose tissue is metabolised. The increase in energy expenditure may affect weight gain.

Infant’s loose heat through conduction, convection, radiation and evaporation

How heat is lost Examples Preventative strategies Conduction Cool x ray plate

Weighing scales Stethoscope

These items should be pre-warmed

Convection Draughts from windows and doors

Use port holes for all procedures

Radiation Cold incubator walls Direct sunlight

Pre warm the incubator Use blinds and incubator covers

Evaporation Cold water

Wet skin Wet nappy

Wet bed from humidity

Keep infant incubator/cot dry.

Use plastic wrap at delivery

STABLE BODY TEMPERATURE : Reference American Academy of Paediatric Perinatal guidelines.

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Neutral thermal Environment (NTE) during first 3 days ( these incubator settings may need adjusted if humidity in use)

Birth Weight (g) Incubator temperature (degrees Celsius) 1000 35 1500 34 2000 33.5 2500 33.2 3000 33 4000 32.5

After Scopes and Ahmed (1966), and Hey and Katz (1970)

Weaning the Incubator temperature in preparation for transition to a cot For preterm infants wean incubator temperature by 0.5 degrees Celsius until 30 degrees is reached provided the infant axilla temperature is maintained within the NTE range.

For term infants weaning is not required. Cloth and wrap the infant adequately when he/she is clinically stable and transfer to an open cot.

Incubator to cot transfer: Factors to consider

Weight Is the infant >1200grams?

Incubator settings Is the incubator in manual mode? Has incubator temperature been weaned to lower range of NTE 30 degrees or less and no humidity required

Body temperature Is the infants body temperature stable 36.5 - 37 degrees Celsius?

Physiologically stable Is the infant clinically well and physiologically stable

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Monitoring on transfer from incubator to cot Temperature monitoring

Frequency of temperature monitoring should be documented in the infants care plan

Check and document axilla temperature hourly for first 3 hours then 3-4 hourly before feeds if within neutral thermal range 36.5 - 37 degrees Celsius.

If temperature falls below normal range readings must be taken every 30-60 minutes and continue until temperature normalises.

Parent education

If an infant is still on monitoring they may be nursed on their abdomen. However, it must be reinforced with parents, when monitoring discontinued

 Put the infants feet to the foot of the cot.  Place the baby on his / her back to sleep.  Prevent over heating

Use of Kanmed Baby Warming System

The Kanmed can be used for Neonates who meet the following criteria

Weight Is the infant >1200 grams?

Incubator settings Is the incubator in manual mode? Has incubator temperature been weaned to lower range of NTE 30 degrees or less.

Body temperature Is the infants body temperature stable 36.6 - 37 degrees Celsius?

Physiologically stable Is the infant clinically well and physiologically stable

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Dress the infant in a nappy, vest baby gro cardigan and hat. Over dressing prevents benefit of conductive heat.

Place blankets over the baby. Start with 2 folded blankets.

Monitor the infant’s temperature 30 minutes after placing in the Kanmed bed. If temperature > 37degrees Celsius remove one blanket at a time monitoring every 30 minutes after removing a layer.

As the baby’s weight increases the temperature is primarily controlled by

changing the amount of blankets that cover the baby and secondly by changing the temperature in 0.5 degrees Celsius increments

When the baby can maintain temperature greater than 36.5 degrees Celsius with the water temperature set at 35.5 - 36 degrees Celsius, the additional heat source is no longer required.

Maintenance of Kanmed bed

1. The baby nest is sent to the hospital laundry department

2. Surface disinfect the water mattress and the heating pad as per manufacturer’s instructions and unit policy. The choice of surface decontamination solution is Actichlor Plus 1:1000 made up as per manufacturer’s instructions

3. Change water every 3 months and add a new bottle of anti-algae.

4. See the user’s manual for further instructions and periodic safety checks.

References:

User manual Kanmed Baby Warmer Art. No BW-50-070/10

McCall EM, Alderdice FA, Halliday HL, Jenkins JG, Vohra S. Interventions to prevent hypothermia at birth in preterm and/or low birth weight babies.

Cochrane Database Syst Rev 2005, Issue 1. Art. No.: CD004210.DOI: 10.1002/14651858.CD004210.pub2. | Article |

American Academy of Pediatrics and American Heart Association (2005). Summary of major changes to the guidelines 2005 AAP/AHA guidelines for neonatal resuscitation. Available at: www.aap.org/nrp/nrpmain.html Accessed 17 October 2006.

References

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