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: 2 Purpose of Procedure/ Guidelines/ Protocol:

1 Children & Young People s Directorate Procedure/Guidelines/Protocol Checklist & Version Control Sheet 1 Name of Procedure/Guidelines/ Protocol: 2 Purpose of Procedure/ Guidelines/ Protocol: Temperature Management in a Neonate 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: N/A Note any issues: 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: 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:

Una Toland Lead Nurse Neonatal Services and ANNP team SH&SCT 6 Equality Screened by: N/A Note any issues: 7 Proposals for dissemination: Una Toland via team managers to nursing staff 8 Proposals for

2 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 These items should be pre-warmed Stethoscope Convection Draughts from windows Use port holes for all Radiation Evaporation and doors Cold incubator walls Direct sunlight Cold water Wet skin Wet nappy Wet bed from humidity procedures Pre warm the incubator Use blinds and incubator covers Keep infant incubator/cot dry. Use plastic wrap at delivery STABLE BODY TEMPERATURE : Reference American Academy of Paediatric Perinatal guidelines degrees Celsius degrees Celsius

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.

3 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) 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 Body temperature Physiologically stable Is the incubator in manual mode? Has incubator temperature been weaned to lower range of NTE 30 degrees or less and no humidity required Is the infants body temperature stable degrees Celsius? Is the infant clinically well and physiologically stable

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.

4 Temperature monitoring Monitoring on transfer from incubator to cot 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 degrees Celsius. If temperature falls below normal range readings must be taken every 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 Physiologically stable Feeding Is the infants body temperature stable degrees Celsius? Is the infant clinically well and physiologically stable Is the infant tolerating feeds?

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

5 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 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 /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.: CD DOI: / CD 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: Accessed 17 October 2006.

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.

MINI - COURSE On TEMPERATURE CONTROL IN THE NEWBORN

MINI - COURSE On TEMPERATURE CONTROL IN THE NEWBORN Instructions: Read each sheet and answer any questions as honestly as possible The first sheets have four questions to allow you to give your thoughts