Thermoregulation 101
What is a normal axillary temperature for an infant?
36.5 - 37.5
Name 3 signs and symptoms of cold stress in an infant.
- Cyanosis or pale/mottled skin
- Poor feeding
- Increased bradycardia/desaturation alarms
- Respiratory distress
- Poor tone
What button should you always press on the giraffe before opening the portholes?
The air boost!
Whose responsibility is it to monitor and intervene for thermoregulation?
The bedside nurse
What is a neutral thermal environment?
The environment in which the baby uses the least amount of energy in order to maintain their temperature.
What happens to a baby's temperature when they are septic?
It can go up or down!
What type of bed should a 38 weeker be admitted into?
A radiant warmer
Name 1 location that you should NOT place a temperature probe.
- Where the baby will be laying on it
- The armpit
- Over the liver
What are 2 positioning devices that we can use for our preemies on skin control?
Roo, gel pad, frog, etc.
What clothing items should an infant in a bassinet be wearing?
A onesie, sleeper, and socks.
BONUS: add a hat to keep them extra warm!
What type of bed should a 32 weeker be admitted into?
A giraffe
Your baby in an open crib has a temperature of 36.3. List 2 interventions you can take to help rewarm this baby.
- Increase the room temperature.
- Warm blankets.
- Kangaroo care.
- Put a hat on.
- If low temperatures persist, they may need an external heating device (giraffe, radiant warmer)
Name the 4 mechanisms of heat loss.
Conduction, convection, radiation, evaporation
List 3 things the bedside RN can do to minimize the risk of cold stress while taking care of an infant in an isolette.
- Utilize the air boost button.
- Use warm blankets to cover the baby during cares.
- Ensure that the temp probe is placed in an approved location.
- Cluster cares
- Monitor bed temperatures at least hourly
How often does the patient's giraffe bed need to be exchanged?
Every 7 days
Your baby in an open crib had a temperature of 36.3. You wrapped them in warm blankets. When should you recheck a temperature?
In 15 minutes.
List 2 reasons why preemies are more at risk than a term infant for heat loss.
- Less brown fat (if any)
- Immature skin
- Blood vessels are closer to the skin
- Poor tone
Name 1 negative outcome of prolonged cold stress.
- Metabolic acidosis.
- Hypoglycemia.
- Respiratory distress.
If the temperature probe is placed over a brown-fat area on an infant, what will happen to the baby's temperature over time?
The baby's temperature will drop!
Rationale: brown fat generates heat. If the temp probe is placed over brown fat areas (axilla, mediastinum, kidneys, adrenals), the probe reading will be high. In turn, the bed will cool down the baby.
Name 1 of the 3 criteria an infant must meet before they transition from skin control to air control in a giraffe.
1. Physiologically stable.
2. Gaining 15-30g/day over the past 3 days.
3. Heat output in the bed is less than 30 C.